MyImpactPage - Northern Health Group/ Performer Volunteer Application Form

Volunteer Consent (Group Application)

NOTE: This application form is only for Individual Entertainers or Performance Groups (performers, church choirs, school groups etc.) who wish to volunteer. Only one representative is required for a Group.

If you are not an individual entertainer or performance group, or if you need more information before you apply, please return to our volunteer home page.

Note this application must be completed in one sitting.

All volunteers must adhere to relevant Northern Health policies, including Confidentiality and Privacy and immunization requirements. By continuing with this application, I am acknowledging on behalf of all group members that they understand and agree with the conditions below. If any group members are age 15 and under, I will ensure appropriate parental consent is in place and oversight is provided by a designated adult during their service.

As the contact for the group, I will distribute all information and/or direction received from Northern Health Authority to each group member. Members will only volunteer during a scheduled group activity and not individually. If any member wishes to volunteer individually they must complete an individual volunteer application and submit to the required screening process.

CONFIDENTIALITY

During their association with Northern Health Authority, group members may have access to information about clients (the term "client" includes patients and residents) and clients' families. At all times, group members will respect the privacy of clients and their families, treating all information about clients and their families as confidential. Group members will not take photos or video recordings of clients. Group members understand that they are prohibited from disclosures of

any kind.

Group members understand and agree to abide by the conditions outlined, which will remain in force even if they cease to have an association with Northern Health Authority. Members understand that if any of these conditions are breached, privileges/association to Northern Health Authority may be terminated.

IMMUNIZATION

Required:

All group members are required to have an annual flu vaccination or wear a mask during flu season (approximately December 1 to March 31st) and be able to provide proof if requested.
All group members must be healthy and free of transmissible illness, not presenting with symptoms such as persistent cough, sore throat, diarrhea, nausea, fever, runny nose etc. during the course of their volunteer activities.
Members may be screened for communicable disease on entry, depending on current restrictions.
At this time, group members are generally not required to be vaccinated for COVID-19 provided they comply with NH guidelines for visitors while on-site.
Immunization requirements may be updated from time to time or in specific locations. The group will comply with any current requirements.

Recommended:

BC Centre for Disease Control recommends that all health care volunteers be up to date and fully immunized for measles, mumps, rubella, chickenpox and hepatitis B (routine childhood immunizations).

PROTECTING YOUR PRIVACY

I give Northern Health Authority permission to keep a record of my confidential personal information. I understand that personal information on this form is collected, used and disclosed by Northern Health Authority in accordance with the Freedom of Information and Protection of Privacy Act of BC (FOIPPA). I understand that Northern Health Authority may engage service providers to host and manage this service on behalf of Northern Health Authority. In such situations, Northern Health Authority will take all reasonable steps to ensure my personal information is treated confidentially, is only used for the purposes described, and is stored securely. I understand this information may be disclosed to any party with legal and proper interest, and release the agency from any liability whatsoever for supplying such information. Note that when we send emails through Better Impact, a third party service based in the United States (US) is used. This means that my name and email address will be temporarily stored in the US for approximately 30 days. If I have any questions about the collection, use and disclosure of my information, I can contact the Northern Health Authority Information Privacy Office by email at privacy@northernhealth.ca.

Thank you for your interest in volunteering!

Please note: Incomplete applications will not be considered

I am new to MyImpactPage.com

You will need to enter a unique username to identify yourself to the system. You should select something that is easy for you to remember such as your email address or your name. Your username must be at least 6 characters long. If the name you enter is already in use by someone else, you will be prompted to choose another username.

Username

Required

	Username must not start with space
	Username must not end with space
	Username must not have two or more spaces in a row

Email Address

Required

Verify Email Address

Required

I acknowledge and accept the above Group Volunteer Consent policies on behalf of the group Required

I already have a username

If you have signed up with this organization before, or are a member of another organization that uses MyImpactPage.com, you can use the same login to access all organizations with which you are associated.

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Password	Required
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I acknowledge and accept the above Group Volunteer Consent policies on behalf of the group Required

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