Youth Volunteer Summer Program 2014

This program is provided by Stony Plain FCSS, Volunteer Centre, and the Youth Centre. If you have any questions please

call us at 780-963-3846.

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TOWN Of STONY PLAIN

Family and Community Support Services

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Youth Volunteer 2014 Registration Form

Your Info:

Name: ______ Age: __ Birthday: ____ _

Address: Postal Code: ------------- ---

Phone #: ____ _

Cell #: ____ _

Email: ----------

School: __________ Grade (Going into): __ _

Do you prefer: D Phone DE-mail

Emergency Contact Info:

Name: Relation: -------- -------

Address: ------------------Work phone #: ____ Home phone #: ____ _

Cell phone #: ___ _

Do you have any special medical conditions that may affect you as a volunteer, or any allergies? Dyes Dno

If yes, please specify (attach an additional sheet ifneeded):

The Important Stuff:

Where did you find out about the youth volunteer program?

o At school oAt Youth Center oNewspaper (Which one? ________ )

o Poster oFriend o Other (Please specify : _______________ )

Tell me about your previous volunteer experience/ relevant work experience:

Sum up your personality in two words: _____ and. ____ _

Please list your volunteer related courses/qualifications: (i.e. First Aid, Babysitting ... )

Which of the following areas are of interest to you? (Choose as many as you like!) oWork w/ children oLeaming new skills oMeeting people oWork w/ animal's o Sports oWorking outside oWork w/ senior's oOther: (Please specify, I'll see what I can do!)

When are you available for volunteering? Days (please circle): Time:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Are there dates you know you won't be available for volunteering? (I.e. Going on vacation, day camps . .. )

Before your registration is complete, please see the attached Authorization for Release of /nfoIl11Jltion!

You're done! Please return your completed registration to

1. The Stony Plain Youth Centre 4902 51 Avenue

2. E-mail: spyc@shaw.ca 3. Fax: 780-963-1951

Give us a call if you have any questions! 780-963-8583

Authorization for Release of Information

I, hereby authorize the release of my personal information to the supervising volunteer agency for the purpose of supervision of the Youth Volunteer Program (an initiative of Stony Plain Family and Community Support Services).

Youth Volunteers and the Parkland Area Volunteer Action Committee are also authorized to take or cause to be taken: still photographs, moving pictures, television and/or sound recordings of myself for educational and publicity purposes.

I hereby waive any and all claims against Stony Plain Family and Community Support Services and in any manner whatsoever relating to the said photographs, recordings and/or information.

I, __________ (parent/guardian) hereby authorize the release of

____________ " my child's personal information to the supervising volunteer agency for the purpose of supervision of the Youth Volunteer Program.

Youth Volunteers and Parkland Area Volunteer Action Committee are also authorized to take or cause to be taken: still photographs, moving pictures, television and/or sound recordings of myself for educational and publicity purposes.

I hereby waive any and all claims against Stony Plain Family and Community Support Services and the Parkland Area Volunteer Action Committee in any matter whatsoever relating to the said photographs, recordings and/or information.

Parent Signature Date

Youth Signature Date

·Personal information refers to only application form, parental/guardian consent and criminal record check (only if requested by supervising organization).

The information collected is under the authority of the Freedom of Information and Protection of Privacy Act. If you have any questions please contact the F.O.I.P. Coordinator at 780-963-2151

I, the parent/guardian give my child permission to be involved with the Youth Volunteer program for the summer of 2014

Parent Signature Date

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Play Daze- Town

Of Stony Plain

Stony Plain

Youth Centre

Stony Plain and Park­

Land Pioneer Museum

Canada Day Celebrations

Town of Stony Plain

Westview Health Centre (Hospital)

Stony Plain Care Centre/ George Henning Place

Stony Plain Public Pool

Multicultural

Heritage Centre

Stony Plain Public

Library

Volunteer Opportunities "'hnt do I do? \' Oil 114'4'd ••••

Helping out with day camps,

field trips, games and crafts!

Help with concessions at community events. Assist with sorting and displaying

Thrift Store donations.

Age 12+

Age 12+

Painting, garden work, yard work, cataloging artifacts, Age 12+

cleaning historic buildings, helping elementary school groups

working on displays, assisting summer students, guiding events

Assisting with different activities for young children,

setting up and supervising the inflatable bouncy castles.

Spend some time chatting with patients and delivering

meal trays.

Assistance with indoor/outdoor activities, bus trips, dining room help, visit residents, going on walks with residents.

Assistance with lessons working with instructors to sing,

play games and help keep all children safe while learning

to swim.

Age 12+

Age 13+, interview and

police information check

Age 13+, interview, orientation

And police information check

Age 12+, Passed kids swim 8

or equivalent

This position is ideal for someone who has an interest in Age 12+

old objects and good organizational skills moving and organizing

objects in storage room, photographing and recording information of objects.

Help out with crafts, activities and the summer reading game Age 13+

at the library.

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