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Client and Family Partner Application Form

First and Last Name
Consent to share your contact information?:
Do you consent to sharing your contact information with Baycrest and the Client and Family Partner Committee Chair for a brief telephone interview, if necessary?
Are you a:

When was your care experience at Baycrest?:

(Check all that apply.)
Have you volunteered at Baycrest in any capacity within the past two years?:
We recognize that our Client and Family Partners have busy lives. How much time are you able to commit to being a client and family partner?:
(Select one)
Are you available to serve as a Partner for at least 2 years? :
(You can still be considered to become a Partner if you answer "no.")
How would you like to help? I want to:

(Check all your interest areas)
To the extent possible, our Client and Family Partners will reflect the diversity of the clients and families serve.
Enter security code:
 Security code