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Loft Ambassador Application
Youth Division – Community Services Department

Thank you for your interest in the Loft Ambassador program! Please take some time to complete the application below. Parent/guardian signatures will be required.

Please note that capacity for the Loft Ambassador program is limited. Loft Ambassadors can volunteer for two hours per shift, up to two times per month. All applicants will be subject to a selection process. Successful Loft Ambassador applicants will be contacted by staff to arrange a training and orientation. Please allow 1 week for a response after submitting an application. If you have any questions, please email youth@aurora.ca.

Section 1: Personal Information, Emergency Contacts &Volunteer Medical Information

First Name

Last Name

Phone Number:

Email Address

Date of Birth (MM/DD/YYYY):

Emergency Contacts

Emergency Contact Name #1:

Emergency Contact Phone Number #1:

Emergency Contact Relation to Applicant #1:

Emergency Contact Name #2:

Emergency Contact Phone Number #2:

Emergency Contact Relation to Applicant #2:

Volunteer Medical Information

Are you have any needs that staff should be aware of? E.g. medical, physical, emotional, behavioural, social.

Yes

Do you have allergies?

Yes

Do you require an EpiPen/Auto Injector for allergic reactions?

Yes

Are you currently taking any medications that you will be required to take during volunteer placement hours?

Yes

Form Builder

Loft Ambassador Application Youth Division – Community Services Department

Section 1: Personal Information, Emergency Contacts &Volunteer Medical Information

Emergency Contacts

Volunteer Medical Information

Loft Ambassador Application
Youth Division – Community Services Department