SECTION THREE: COMPLETE ONLY IF YOU ARE APPLYING TO VOLUNTEER IN THE EXERCISE PROGRAM
1. Education Level:
CEP CPT 3. Other Training
4. Do you presently have Professional Liability Insurance?
5. Medical Oncology Knowledge – if so, please elaborate
6. Do you have experience in working with persons with cancer or other clinical populations (please specify)
7. Do you currently work as a trainer/practitioner?
8. From your perspective, what would your volunteer commitment at Wellspring look like?
9. Desired volunteer experience: ie: (room supervision, exercise class, individual trainer, assistant, other)
10. Are you interested in receiving advanced training specific to work with persons with cancer?
Please read the following Code of Ethics and Confidentiality – indicate you are in agreement by signing.
If accepted at Wellspring Edmonton, I agree to the following:
1. I will not endorse or sell products, or services.
2. I will not promote myself or others for personal gain.
3. I will not provide any form of additional treatment information to the client.
All information learned from any client in Wellspring care will be kept in the strictest confidence and will only be shared, if appropriate, with Wellspring staff as necessary. I accept these term and conditions