ACSA's COVID-19 Volunteer Sign-Up
This is a volunteer application form to sign up to help provide relief to residents of Scarborough during the COVID-19 pandemic.
***We will not share your information with anyone else, and will only be used for the purpose of coordinating relief efforts***
This effort is a coordinated effort from Agincourt Community Services Association.
* If you are unsure about filling out this form, but want more information, please contact us at icarmen@agincourtcommunityservices.com



Food Bank Location: 1911 Kennedy Road, Unit 105, Scarborough (Ward 20)

Garden Locations: 201 Chester Le Boulevard, 200 Tiffield Road, and 2850 Midland Avenue


Why now?
During this COVID-19 pandemic, we know that many people who are already marginalized will face barriers to accessing the necessities of life, and many people are facing hardship because of being in isolation, financial losses, and cancelling of regular services in the community. In times of crisis, we know that many people can be left behind, and the best way to prevent this is to care for each other in our communities. If you are interested in being a part of these efforts, please fill out the form below:
First Name *
Last Name *
Age Group *
Address (Street/ Unit # /City/ Province/ Postal Code) *
Phone Number *
Alternative Phone Number *
Email *
Emergency Contact - Name- relationship - contact number. Example: Jane Doe- spouse- 100 000 0000 *
Volunteer Position *
Required
Shift Availability (weekly commitment for at least 2 months) *
Required
Are you okay with volunteering the same day/time weekly? *
Are you able to help with donations? *
Required
Please list below any relevant skills, work experience or courses that could help you in your volunteer role. For example: technical skills, medical skills, disaster or public health training. etc
What languages can you speak and read (including ASL)? * *
Do you have any of the following:
Acute Infections Illness Screening
*NOTE: If you are immune-compromised or an elderly person, you may not develop a fever.
Do you have a new onset of fever*, chills or shakes, new or worsening cough and/or shortness of breath, diarrhea and/or abdominal pain? *
Have you had contact with a person who has tested positive for COVID-19 in the last 14 days? *
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