Palliative Services
Bereavement Support
Education & Planning
Thrift Store
About Us
Volunteer
Events
Hike for Hospice
Friends of BHS
Donate
Program Volunteer
Applicant Form
Please fill out the form below.
Mailing Address
FIRST NAME
last name
Select one...
Female
Male
Non-Binary
Other
Prefer not to say.
Gender
date of birth
( YYYY/MM/DD )
Basic Information
STREET ADDRESS
CITY
POSTAL CODE
Contact Information
Home Telephone
mobile/cell number
email address
How did you hear about us?
Anything else you would like us to know?
Languages spoken
Current commitments or obligations
What interests you in becoming a Hospice Palliative Care volunteer at this time?
Work Background
Referral Source
Select one...
Burnaby Hospice Society Website
Charity Village / Volunteer Website
Community Volunteer Organization
Current Volunteer
Fundraiser Event
Newspaper
Other
Personal Loss History
Skills
Emergency Contact
full name
PHONE number
Reference #1
full name
email address
Reference #2
full name
email address
I confirm that I am over the age of 21
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
