VOLUNTEER APPLICATION FORM

Thank you for your interest in volunteering with the Victoria Stroke Recovery Association.

This online application contains all the requirements from the official Volunteer Application Form. If you prefer to print and submit the application manually, or if you require a copy for your records, please download the Volunteer Application Form.

About the Victoria Stroke Recovery Association

The Victoria Stroke Recovery Association (VSRA) is a self-support group for stroke survivors and their families. The weekly program includes communication and adaptive physical-exercise groups, stroke-survivor and care-partner support groups as well as social/coffee time, educational presentations, games, activities and entertainment. We have Thanksgiving and Christmas luncheons and an annual summer picnic.

Volunteer Roles and Duties

Weekly volunteer duties include table set up, making and serving tea and coffee, kitchen cleanup and, most importantly, welcoming and engaging with members. Our Thanksgiving luncheon requires some additional food preparation and clean up, and the picnic has extra tasks. The Christmas luncheon is held elsewhere and is attended by volunteers with no work involved!

Criminal Record Check

To volunteer with the VSRA, you are required to do a “Voluntary Criminal Background Check for a Person Requesting to Work with Vulnerable Adults” every five years. The criminal record check (CRC) is free because it’s for a volunteer organization. Here is how you apply:

- Submit an electronic criminal record check (eCRC) application
- Access Code: DBHVQFJ236

Recommended Training

Because many of our members have communication challenges, it would be helpful for you to complete the free 40-minute Introduction to Supported Communication for Adults with Aphasia (SCA™) eLearning Module. Here’s how:

- Create a Community Hub account on the Aphasia Institute website
  - Role: Other
  - Profession: Volunteer
  - Where Do You Practice?: British Columbia
- Then click this link to complete the training (press the yellow START NOW button)
- At the end of the eLearning module, you will receive a certificate of completion.

Please email this to Mary-Anne Gibbs

Approval and Contact Information

All applications will be reviewed and approved by the VSRA Board. The decision of the Board regarding each application will be conveyed to the applicant.

For more information or any questions, please contact:
Mary-Anne Gibbs, Coordinator
778-350-8772

Volunteer Application Form

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This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Address(Required)

Street Address City Province Postal Code

Phone(Required)

Email(Required)

Date of Birth (Month)(Required)

Date of Birth (Day)(Required)

How did you hear about us?(Required)

What made you want to volunteer with VSRA?(Required)

Have you volunteered in the past? If so, where?(Required)

Please provide the name and contact of a reference person.(Required)

What do you bring to volunteering at VSRA?(Required)

eg: likes to engage with people, organizing, kitchen and/or serving skills, audio-visual equipment/technology skills...

What are your interests/hobbies(Required)

Are there any tasks or situations you would be uncomfortable in or dislike?

Consents and Releases

Privacy Policy

The Victoria Stroke Recovery Association protects the privacy of individual members. The personal information obtained in this application form may be used only in the administration of programs offered by VSRA.

Volunteer Waiver of Liability

The Victoria Stroke Recovery Association is dedicated to ensuring the health and safety of all participants.

By submitting this application, I acknowledge that my participation in the VSRA is voluntary.

The Victoria Stroke Recovery Association is not responsible for any injury, illness, disability, death, or property damage that happens when:

I participate in VSRA activities; or
I am on the program site or after I leave the site.

Waiver Acknowledgement(Required)

I acknowledge that my participation is voluntary, and I agree to the Waiver of Liability above.

Directory Consent(Required)

The VSRA prints a member directory each year so that members can contact each other outside of group time. By consenting, you permit the VSRA Member Directory to contain your name, suburb, telephone number (cell and/or home), and email address.

Yes, I consent to be listed in the Directory.

No, I do not wish to be listed.

Confidentiality Agreement(Required)

I agree not to disclose any personal information about group members to anyone outside the group.

Consent to Share Stories, Photos, and Videos(Required)

I give permission for the Victoria Stroke Recovery Association (VSRA) to use my name, photo, video, or work for educational and promotional purposes. This may include use in newsletters, brochures, resource guides, presentations at workshops or conferences, on the VSRA website and social media (e.g., Facebook), and in fundraising or training materials. I understand that these materials will be used positively to promote stroke recovery support, and that I can withdraw or change my consent at any time.

Yes, I consent to the use of my media/stories.

No, I do not consent.

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