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Company/Organization

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Address Line 2:

City/Town:

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Postal Code:

Home Phone:

Work Phone:

E-Mail:

Please check your areas of interest:

Home Support Volunteer Opportunities:

Respite (Caregiver Relief) - Day Program Opportunities:

Transportation:		Friendly Visiting:
Meals on Wheels:		Telephone
Luncheon Out:		Reassurance:
Foot Care Clinic:		Office Support:

Pickering:
Clarington:
Uxbridge:

COPE Mental Health Volunteer Opportunities:

Other Volunteer Opportunities:

Individual Support:
Group Support:

Board Member:
Local Advisory Committee Member :
Fundraising & Events:

Please check where you would like to volunteer:

Ajax/Pickering:		Scugog:
Brock:		Uxbridge:
Clarington:		Whitby:
Oshawa:

Brokered Services:

Home Help: (light housekeeping)
Home Maintenance: (yard work & snow shovelling)

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Volunteer Form

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