Sanguen's Initial Volunteer Check In Form
Please fill out this form. If you have any questions please reach out to Bree at 226-332-3220 or volunteer@sanguen.com 

We will only be using your email to contact you for Volunteering communications.
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Email *
Name *
 Pronoun(s)(ex. She/her, They/them, He/Him,...) *
Phone number
Are you vaccinated for Covid 19? *
What level of Covid 19 vaccination do you have? *
Are you able to show proof of vaccination and ID to Sanguen staff prior to working/volunteering with us? *
How did you hear about Sanguen?
Why would you like to Volunteer at Sanguen?
Availability(We currently only have a few things available for Volunteers, however, this could be useful for planning future events.)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning(9am-12pm)
Afternoon(12pm-4pm)
Evening(4pm-8pm)
What cities would you be able to volunteer in? (Again, currently we have limited opportunities for Volunteers specifically, but this could aid in future planning)
Have you read the Confidentiality Agreement in the picture below? *
Confidentiality Agreement reads: I, the undersigned, understand that maintaining confidentiality is one of the most important parts of volunteering for Sanguen Health Centre. I have been given a copy of this agreement to take home and keep for my own records.I understand that confidentiality means that I do not discuss other people’s information with anyone – including my family and friends. If I have a concern about a client, patient, community member, or staff, I will speak directly to my supervisor to ask for help.I understand that confidentiality applies to (but is not limited to):Personal information about clients, patients, community members and staff. Examples include names, addresses, phone numbers, relationships, education, sexual orientation, legal information (charges or records), etc.Medical information about clients, patients, community members and staff, including mental health, physical health, any health-related diagnoses (including, but not limited to Hepatitis C and HIV), addictions, drug use, and other issues.Harm reduction supplies, including what items a person takes, the quantity of supplies taken, when or where supplies are taken. Information about supplies is only to be used, in code, for statistical purposes.All paperwork, forms, applications or other documents that I may use or see while I'm working.I agree that, if I don't know how to handle a situation, I will immediately contact a supervisor and ask for help.I understand that if I break the rules of confidentiality, I must discuss this with my supervisor, and that breaking confidentiality may mean that I am no longer able to assist Sanguen Health Centre with outreach work.            Signed: __________________________________ Witnessed: ____________________________ Date: ___________________________________ Print Name: ____________________________
I, the undersigned, understand that maintaining confidentiality is one of the most important parts of volunteering for Sanguen Health Centre. I have been given a copy of this agreement to take home and keep for my own records.I understand that confidentiality means that I do not discuss other people’s information with anyone – including my family and friends. If I have a concern about a client, patient, community member, or staff, I will speak directly to my supervisor to ask for help.I understand that confidentiality applies to (but is not limited to):Personal information about clients, patients, community members and staff. Examples include names, addresses, phone numbers, relationships, education, sexual orientation, legal information (charges or records), etc.Medical information about clients, patients, community members and staff, including mental health, physical health, any health-related diagnoses (including, but not limited to Hepatitis C and HIV), addictions, drug use, and other issues.Harm reduction supplies, including what items a person takes, the quantity of supplies taken, when or where supplies are taken. Information about supplies is only to be used, in code, for statistical purposes.All paperwork, forms, applications or other documents that I may use or see while I'm working.I agree that, if I don't know how to handle a situation, I will immediately contact a supervisor and ask for help.I understand that if I break the rules of confidentiality, I must discuss this with my supervisor, and that breaking confidentiality may mean that I am no longer able to assist Sanguen Health Centre with outreach work.                                        Signed: __________________________________ Witnessed: ____________________________ Date: ___________________________________ Print Name: ____________________________ *
Please reach out if you would like to discuss anything or have any questions. Is there anything you need specifically from us? Have any ideas you'd like to share?
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