Name:____________________________________________________
Street Address:_____________________________________________
City: ________________________ Postal Code:_____________
Home Phone: (519)____________Work Phone: (519)___________
Email:__________________________________________________
Cell Phone: ( ___)____________

Availability: Check all that apply)

Saturday October 13 9:30am to 1:00pm__________ 1:00 to 4:30_______________

Sunday October 14  9:30 to 1:00pm____________ 1:00 to 4:30 ______________

Prior to event dates: _________am _________pm

Preferred Location (if any)
In town - Kincardine________ Tiverton_________
Bruce Township______________________________
Kincardine Township__________________________
Deliveries: (requires a car)______________________
Office / Admin:_______________________________

Specific site preference (cannot be guaranteed)________________________________________________________

Person to notify in case of emergency (Name and Phone number)
____________________________________________________________________________________________

I understand that, if this the first time I am volunteering, I must attend an orientation workshop prior to the event.

Signature of Volunteer ___________________________________________________
Date:_______________

___Student Vounteer (All volunteer hours are eligible for Student Community Service)

Following to be filled in by the Doors Open Kincardine Committee:
Assigned Location:___________________ Time and Date: _____________________

Please complete this form and e-mail it to doorsopenkincardin@bmts.com, fax it to 519-396-6062, mail it to Doors Open Kincardine, C/O Rigby, P.O. Box 338, Kincardine, ON N2Z 2Y8 or phone 519-396-6060 and someone will pick it up.