Become a volunteer at a long-term care home

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Use this form to apply to become a volunteer at a long-term care home.

Before you start

You need:

the name and phone number of an emergency contact person;
the names and phone numbers of two references who have known you for at least one year;
an email address or phone number so that we can contact you about your application.
If you are under 18 years of age you will also need a letter of consent from a parent or guardian.

Other ways to apply

If you prefer a printable version of this form, you can download a copy here.

A note about privacy

Personal information contained in this form is collected under the authority of Section 29(c) of the Access to Information and Protection of Privacy Act, and used for screening volunteer applicants administered by the Continuing Care volunteer program.

For more information about the collection, use and disclosure of your personal information, please contact: Supervisor, Recreation and Psychosocial Services, Health and Social Services, at 867-667-9385, or toll free at 1-800-661-0408, or in writing at mail code H-24, Box 2703, Whitehorse, Yukon, Y1A 2C6.

YG(5529HSS) Rev.11/2021