Volunteer Application Form

Volunteers play a vital role in the delivery of our programs in the community. All volunteer applications are reviewed with consideration of current volunteer opportunities.

Depending on the position applied for, candidates may be required to complete a Police check and/or participate in an interview.

Niagara Region Public Health would like to thank you for your expressed interested in volunteering with us.

Volunteer Application Form

* = Required

Contact Info

Name *

Address *

City *


Postal Code *

Home Phone xxx-xxx-xxxx *

Cell Phone xxx-xxx-xxxx


Birthday   *




What best describes your current situation?



Do you have reliable transportation within the Niagara Region?


What type of volunteer position are you applying for? (Select one)


How many hours can you volunteer per week?  


When are you available to volunteer (click all that apply)?

Emergency Contact Info

If you are volunteering with us, and an emergency arises, whom should we contact?

Name *

Home Phone xxx-xxx-xxxx *

Alternate Phone ext.


Provide us with two non-family references that we can contact on your behalf.

Reference 1 Name *

Reference 1 Email *

Reference 2 Name *

Reference 2 Email *


Additional Information

Provide any relevant experience and education relating to the position you are applying for.

Why do you want to volunteer with Niagara Region Public Health?

Provide any additional information you would like to share with us

Verify your Submission

Type the six digits shown in the box:

Type in this Number Below
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