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Title:
First Name:
Last Name:
Company/Organization
Address Line 1:
Address Line 2:
City/Town:
Province:
Postal Code:
Home Phone:
Work Phone:
E-Mail:
Please check your areas of interest:
Home Support Volunteer Opportunities:
Respite (Caregiver Relief) - Adult Day Program Opportunities:
Transportation: Friendly Visiting:
Meals on Wheels: Telephone  
Luncheon Out: Reassurance:
Foot Care Clinic: Office Support:
Pickering:
Clarington:
Uxbridge:
Whitby:  
COPE Mental Health Volunteer Opportunities:
Other Volunteer Opportunities:
Group Support:
Board Member:
Local Advisory Committee Member :
Fundraising & Events:
Community Events Display Volunteer:  
Dining Assistant:  
Please check where you would like to volunteer:
Ajax/Pickering: Scugog:
Brock: Uxbridge:
Clarington: Whitby:
Oshawa:
Brokered Services:
Home Help: (light housekeeping)
Home Maintenance: (yard work & snow shovelling)
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Volunteer Form
Please check carefully that all of your information is accurate and complete. All information is strictly confidential and is intended for the sole use of Community Care Durham. For information about our privacy policy, view Community Care Durham's Privacy Policy.