Operation Red Nose St-Malo Volunteer Registration Form
Please have your valid Manitoba driver's license (or other acceptable form of ID) ready when filling out this form.
It will take approximately 5 minutes to complete.
Your registration confirmation will be emailed to you.
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Full name as it appears on your ID (driver's license).
Date of Birth (MM/DD/YEAR)
Telephone number (cell)
(Your volunteer details will be texted to this cell number closer to your volunteer date. If you do not have a cell, please type "no cell".)
Telephone number (home)
Address (Physical, Mailing, Town, Province, Postal Code)
Ride nights you are available to volunteer
If you select multiple dates, our volunteer coordinator will be in touch with you to confirm your night(s)
Friday, November 24, 2023, 8pm to 3am
Saturday, November 25, 2023, 8pm to 3am
Friday, December 1, 2023, 8pm to 3am
Saturday, December 2, 2023, 8pm to 3am
Friday, December 8, 2023, 8pm to 3am
Saturday, December 9, 2023, 8pm to 3am
Friday, December 15, 2023, 8pm to 3am
Saturday, December 16, 2023, 8pm to 3am
Friday, December 22, 2023, 8pm to 3am
Saturday, December 23, 2023, 8pm to 3am
Friday, December 29, 2023, 8pm to 3am
Saturday, December 30, 2023, 8pm to 3am
Sunday, December 31, 2023, 8pm to 3am
Are you registering as
a ride team
If you registered as a ride team, please indicate the 2 (or 3) others on your team
Note: each ride team member must fill out their own individual volunteer registration forms
Volunteer duties you are interested in
Dispatcher: Person who stays at headquarters answering phone calls and dispatching ride teams (must be 16+)
Escort Driver: Person who escorts the Client Driver and the Navigator in own vehicle (must be 18+ and have a valid class 5 driver's licence and vehicle)
Client Driver: Person who drives the client's vehicle (must be 21+ and have a valid Class 5 driver's licence)
Navigator: Person who rides with the Client Driver in the client's vehicle (must be 18+)
I'm on a ride team. We'll figure out our roles on our ride night.
Driver's license number (9 digits)
Driver's license expiry date (MM/DD/YEAR)
Do you drive standard?
Do you have any license restrictions?
If you aswered yes to the above question, please indicate the restrictions.
Please read the below carefully and answer the questions truthfully to self-declare your criminal record.
If the statement is correct, check the box.
I have not been convicted of a criminal offence in Canada or elsewhere or, if I have been convicted of a criminal offence, I have obtained a pardon.
I have been convicted, in Canada or elsewhere, of one or more criminal offences.
I am not subject to any pending charges for a criminal offence in Canada or elsewhere.
I am subject to one or more pending charges, in Canada or elsewhere, for one or more criminal offences.
I am not subject to any court order made against me in Canada or elsewhere.
I am subject to one or more court orders made against me in Canada or elsewhere.
If you have been convicted of a criminal offence, and/or are subject to one or more pending charges or court orders, please provide details below.
Offence/charge/order, date, place of the event
Authorization, consent and declaration
By checking the box, you authorize the corresponding statements. Operation Red Nose reserves the right to terminate volunteer participation for current and future compaigns.
I consent to the use of my name, image and likeness in the form of photographs for promotional purposes by Operation Red Nose, its partners, affiliates, agents, employees, representatives, licensees and assigns, without notification or compensation.
I authorize Operation Red Nose St.Malo to contact me throughout the campaign.
I authorize Operation Red Nose (ORN) and any police service with jurisdiction over any or all parts of the province in which I reside to conduct a criminal record check to ensure that I meet the selection criteria set out by ORN. However, only judicial antecedents that ORN deems to be incompatible with the volunteer’s assignment will be taken into account. If my assignment requires the driving of a road vehicle, I authorize ORN and any police force to check the validity of my driver’s licence. I also give my consent to the police force to forward the results of the background checks to ORN. A false declaration will result in the refusal of the application.
I agree that between the time I submit this form and the time I participate as a volunteer, I will inform ORN of any new charge(s) against me relating to an offence and any conviction(s) in connection with such an offence. In accordance with the relevant legislation, ORN and its representative agree to protect the confidentiality of all information and data about the organization’s clients and volunteers. Any declaration form that has not been signed or that contains unanswered questions will be considered incomplete and returned to sender.
I agree to take all necessary precautions to ensure the safety of my team and of Operation Red Nose clients by complying with, among others, the traffic laws in my province (speed limits, use of seatbelts, signage, parking, etc.). Operation Red Nose is not responsible for any ticket received during the course of my volunteer duties.
I agree to comply with the Operation Red Nose (ORN) code of ethics: Sobriety: I must not consume any alcohol or cannabis on the day I work with ORN; Confidentiality: All information about ORN clients and volunteers that is disclosed to me will remain confidential and will not be used for any purpose other than to fulfill the mandate conferred upon me. I will also not discuss any details with other volunteers that could be used to identify a client or volunteer; Courtesy: I will show patience and courtesy toward clients at all times; Free service: ORN is a free service. I will never solicit donations, but if clients wish to make a donation, I will thank them; Fatigue: I will not overestimate my capabilities and, if necessary, I will take a nap before reporting for duty as an ORN volunteer; Mutual respect: All ORN volunteers, whether in headquarters or on the road, deserve my full respect and consideration.
I agree to return to Operation Red Nose all amounts given to me by clients (donations, tips, gifts, etc.).
I certify that the information provided in this declaration is accurate and complete.
By checking the Yes checkbox you are indicating that all of the above information is true.
The Yes confirms your electronic sign-off of the information you filled out on this form.
Send me a copy of my responses.
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