CHANGE Health Community Program Volunteer Registration
The CHANGE Health Community Program supports Alberta families to learn, or re-learn healthy living through lifelong healthy nutrition, active lifestyles, mental well-being and positive social connections.
Parents and children will learn alongside of health professionals about nutrition, physical activity, mental wellbeing and
social connections in their community. We are inviting families in your community to participate in this research-based
program.
* Required
Section I Contact Information
Last Name
*
Your answer
First Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Prefer not to say
Other:
Apt #
Your answer
Street #
*
Your answer
City
*
Your answer
Province
*
Choose
AB
BC
SK
MB
ON
QC
NB
NS
PE
YK
NL
NT
NU
Other
Postal Code
*
Your answer
Email Address
*
Your answer
Home Phone
*
Your answer
Work Phone
Your answer
Emergency Contact Name & Phone Number
Your answer
Section II Volunteer and Work Experience
Please list any related work or volunteer experience
Your answer
Please list any current related education or certifications
Your answer
Do you have a current First Aid & CPR and Food Safety Certification?
Your answer
Are you involved in any community activities or have any affiliations with any community organizations? (clubs, service organizations, etc)
Your answer
Why are you interested in volunteering with the CHANGE Health Community Program?
Your answer
What language(s) do you speak?
Your answer
Do you have any allergies?
Your answer
Section III Availability and Volunteer Assignment Preferences
CHANGE Health Community Programs typically run in the evenings throughout the week. Special activities may also run outside of regular program hours. Please let us know your availability by checking dates and times that apply.
Morning (9am to Noon)
Afternoon (Noon to 4pm)
Evening (4pm to 8pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning (9am to Noon)
Afternoon (Noon to 4pm)
Evening (4pm to 8pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
The CHCP Program currently runs at the following locations. Please indicate if you have a preference of which location you would like to volunteer at:
Parkdale Community Hall (Wednesdays, 5:00-8:00 pm)
McKernan School (Thursdays, 5:30- 8:30 pm)
St. Bernadette School (Mondays, 5:00-8:00 pm)
High Park School (Thursdays, 5:00-8:00) @ 40 Highridge Way, Stony Plain
WoodHaven School (Wednesdays, 5:00-8:00) @ 475 King St, Spruce Grove
Doesn't Matter
Section IV
Additional Information
Do you have access to a personal vehicle?
Yes
No
Clear selection
How did you hear about us?
Website
Social Media
Recommendation
Word of Mouth
Others
Clear selection
Please note that all volunteers are required to complete a Police Information check prior to volunteering
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of University of Alberta.
Report Abuse
Forms
