Volunteer Application Page 1 of 3
A Niagara Region Charity Providing
Educational, Recreational, and Respite Programs
for Children and Youth with Special Needs
Volunteer Application Form
Date:_____________________________________
Please fill out all of the information on this form. It helps us know your area of interest and
availability to volunteer. This information may be used for data entry and emergency
situations.
What program(s) are you interested in volunteering in? please check all that apply
 Weekend Respite
 Saturday Camp
 Adult Day Program
 Horseback Riding
 Teen Night
 Summer Camp
Name: _________________________________________________
Full Address (house number, street name, city, postal code):
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Home Phone: ____________________________________ Cell: _____________________________________
Email Address: _____________________________________________________________________________
Age (Volunteers must be 16 years of age or older):
 16 - 18 years (police check required for Respite Program)
 Over 18 years (police check required for all programs)
Emergency Information:
Health Card #: ______________________________________________________________________________
Family Doctor’s Name & Phone Number:
_________________________________________________________________________________________________
Please visit www.redroofretreat.com for more information.
Contact Karissa Vantwel at karissa@redroofretreat.com or (289) 228 - 2767 for further questions.
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Emergency Contact:
Name:_______________________________________ Relationship: _______________________________
Home Phone: ___________________________________
Cell: __________________________________
Previous/Present Volunteer Experience:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Personal skills/training/hobbies/interests:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
How did you hear about Red Roof Retreat?
_________________________________________________________________________________________________
Why do you want to volunteer at Red Roof Retreat?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
References (cannot be relatives or friends):
Name:______________________________________ Phone Number:_______________________________
Relationship: _______________________________________________________________________________
Name:______________________________________ Phone Number:_______________________________
Relationship: _______________________________________________________________________________
Acknowledgement and Agreement:
During your volunteer role at Red Roof Retreat, you will be working with a variety of
children with special needs. Confidentiality is of utmost importance.
Many of them have cognitive, emotional, physical, medical and/or behavioural issues.
Unexpected or aggressive behaviours could include hitting, biting, resistance, running away
etc.
Please visit www.redroofretreat.com for more information.
Contact Karissa Vantwel at karissa@redroofretreat.com or (289) 228 - 2767 for further questions.
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You will be provided with a brief orientation on your first day of volunteering.(check with
the Volunteer Coordinator for times/details) This orientation in no way can cover all of the
circumstances that could arise while working at Red Roof Retreat, however, it will provide a
framework of what to expect.
You may be assigned a child or young adult to be your “buddy” for your visit and you will be
responsible for them and make sure they are always within sight and within “arms length”,
and participating in activities. At other times you may be given a task to do related to the
program you are in.
Our staff are there to support you and give you guidance on how to work with the children.
Please ask for assistance, or direct any questions you have to them as soon as they arise.
You WILL NOT be responsible for your child’s personal care or medications. You will be part
of a group, and WILL NEVER be left alone with a child. You MUST NEVER leave your child
alone.
No cell phones are permitted during program time. They can be placed in a locked cupboard.
If you feel someone needs to get a hold of you for emergencies, please give them your
supervisor’s phone number and they will relay any messages.
You will need to consider this volunteer placement seriously, much like a job. You will need
to be on time and prepared to work. You must report directly to the Camp Supervisor for
any changes in attendance, if there is a concern about your “buddy”, or if you witness any
unusual occurrence.
You must bring a swimsuit and be prepared to swim with your “buddy” each day. You must
also bring a lunch and plenty of water.
Please check your program hours and report in at the correct time. Please sign out when
leaving.
Once you begin your volunteer role, please ask for your supervisor’s phone number in case
you need to get a hold of them in an emergency .
Please sign below if you have read and understood the above application.
By signing this form you confirm that you are 16 years of age or older and agree to all of the terms and
conditions that may be listed on this Volunteer Application form. You also confirm that you have read
and understand all job requirements as listed on the ‘Volunteer Job Description’ pertaining to your
program of interest at Red Roof Retreat. Red Roof Retreat reserves the right to accept volunteers into
any program at the discretion of the Volunteer Coordinator and/or Executive Director.
Name (print)__________________________________________
Name (sign)___________________________________________
Date________________________________________________
Witness (print)________________________________________
Witness (sign)_________________________________________
Date_________________________________________________
Please visit www.redroofretreat.com for more information.
Contact Karissa Vantwel at karissa@redroofretreat.com or (289) 228 - 2767 for further questions.