Wellspring Niagara

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Online Programs

Well on the Web is an extension of the programs available in the Wellspring Centres across the country, enabling those who live far from a physical centres, or those not well enough to leave their homes, with access to Wellspring’s special brand of care and support.

Well on the Web

First name *

Last name *

Street Address

Postal Code

Home Number *

Mobile Number

Work Number

Email *

1. Are you registered with Wellspring as a member?

2. Please indicate the role(s) in which you are interested in helping:

While Wellspring has a number of volunteer roles, we welcome volunteers with a diversity of skills and experience to help out with a variety of areas that may not be listed here. If you are interested in more than one area, please circle the role that most interests you. Please note that volunteers will be asked to provide us with an acceptable Police Record Check for several of the volunteer roles listed below.

Peer Support (must be a cancer patient or a caregiver of a cancer patient, and at least 18 years of age) Reception/ Front Desk Energy Volunteer — Healing Touch, Therapeutic Touch, Reiki Practitioner or Energy Therapist

Please note that Wellspring requires the following minimum qualifications:

Role	Qualifications
Reiki	2nd Degree
Therapeutic Touch	Recognized Practitioner
Healing Touch	Certified HT Practitioner
Energy Therapy	Professional Studies Diploma
Plus a minimum of 20 treatments

Support Group Co-facilitator (must be a cancer patient or caregiver of a cancer patient, and have previously participated in a support group) Fundraising Events (assisting with special events) Other (please specify):

3. Cancer experience (if any):

Relation to a person with cancer:

Self Family Member Friend Other:

Cancer Site/Type:

4. Do you speak a second language?

a) If yes, which one(s): b) Would you be comfortable offering Peer Support in this language?

5. Tell us your availability (check all that apply): Daytime Evening and Weekend

6. Have you volunteered for other organizations? If you have, then briefly describe the duties you had.

7. Do you have any special skills or experiences that would be helpful as a Wellspring volunteer?

8. We recognize that people who volunteer their time do so for specific reasons. What do you hope to develop or gain through your volunteer experience at Wellspring?

9. Please provide us with at least one professional and other volunteer placement references.

(1) Name and Title (1) Email (1) Relationship to you and how long you have known this person: (2) Name and Title (2) Email (2) Relationship to you and how long you have known this person: (3) Name and Title (3) Email (3) Relationship to you and how long you have known this person:

Wellspring Niagara

Volunteer Application Form:

Wellspring Niagara

Your contact details:

Monday	9 am - 4:30 pm
Tuesday	9 am - 4:30 pm
Wednesday	9 am - 4:30 pm
Thursday	9 am - 4:30 pm
Friday	9 am - 4:30 pm