*
First Name:*
Last Name:*
Address:*
City:*
Province:*
Postal Code:*
Phone Number:*
Alternate Phone Number:
Email:*
What is your employment status? Student Employed Unemployed Retired
What is your citizenship status in Canada?*
If you are here on a visa, what is the termination date of your visa?
Name of parent/guardian
Parent/guardian phone number
How fluent are you English:* Speaking: Fluent Semi-Fluent Conversation Level Basic Understanding None
Writing: Fluent Semi-Fluent Conversation Level Basic Understanding None
Reading: Fluent Semi-Fluent Conversation Level Basic Understanding None
How fluent are you Japanese:* Speaking: Fluent Semi-Fluent Conversation Level Basic Understanding None
How long would you like to volunteer with us?* Months:
Hours per Week:
Why are you interested in the positions you have marked?*
Do you play any instruments?
Do you like to sing?
Do you enjoy arts and crafts?
Have you ever worked with seniors before?(describe)
Please provide two references*
Do you agree to a criminal record check?* Yes No
English (Canada) 
日本語