Volunteer Breastfeeding Buddies Peer Support

Contact Information

First Name

Last Name

Address

City

Postal Code

Phone

Preferred method of contact?

Emergency Contact

Full Name

Relationship to Volunteer

Day Time Phone Number

After Hours Phone Number

Language Spoken

English

French

Other

Breastfeeding Information

Experience with breastfeeding

Duration of breastfeeding (total of all breastfeeding experiences)

Previous volunteer experience? Please describe:

Personal References

Name

Phone Number

Name

Phone Number

Acknowledgements

I understand that by submitting this application, I am not guaranteed a volunteer role nor am I required to accept any role offered to me.

I acknowledge that all roles will require a police record check and training.

Thank you for your interest. Timiskaming Health Unit will contact all applicants who meet the volunteer criteria.

*Information is required in all fields to submit form.

(Submit to go to Submit to go to hbhc@timiskaminghu.com.

The information on this form is being collected for volunteer placement purposes in compliance with the Municipal Freedom of Information and Protection of Privacy Act. If you have any questions regarding the collection and use of this information, please contact the Privacy Officer at 705-647-4305.