Days of Caring - Workplace Volunteer Request

Username: *

Password: *

Date of Submission: *

Company/Organization Name: *

Company Address: *

Contact Name: *

Phone: *

Email: *

Will you be participating?: *

Yes

Alternate Contact Name:

Alternate Contact Phone:

Alternate Contact Email:

Who should we contact and liase with when arranging a Day of Caring?: *

Me (primary contact)

Alternate Contact

Has your company/organization participated in community volunteer activities?: *

Yes

If 'yes', please provide details:

Are you interested in a particular United Way serviced area in Renfrew County?: *

Considering the dates of Day of Caring, what date would you prefer?: *

Is this date flexible?: *

Yes

Preferred time of day?: *

How long would you like the Day of Caring activity to be?: *

Estimate volunteer group size?: *

Wheelchair access required?: *

yes

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Are seniors’ needs well met in Renfrew County in terms of health & social services, housing etc:

Yes

I don't know