*
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 status in Canada?* Citizen Permanent Resident Working Holiday Visa Work Permit Student Visa
If you are here on a visa, what is the termination date of your visa?
Name of Emergency Contact
Emergency Contact 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? (minimum six months)* Months:
Hours per Week:
Why are you interested in the positions you have marked?*
Do you play any instruments?
Do you like to sing?
What type of music do you enjoy
What type of art do you enjoy
Have you ever worked with seniors before? Yes No
Please provide two references*
Do you agree to a criminal record check?*
Yes
English (Canada) 
日本語