We encourage feedback on any and all issues of concern to residents. Please join us at our monthly meetings to discuss issues or send an email to President@khca.on.ca. We look forward to hearing your views!

Saturday, March 10, 2012

Pathway Patrols in Kanata


Should you be interested in the Pathway Patrol.  The following is the details of the program. 

As well there are an application and a waiver that must be filled out and signed if you are interested in becoming a volunteer with the Pathway Patrol program.

They can then be returned to Gord Macgregor:
City Wide Sports,  100 Constellation Crescent,    8th floor west,    Ottawa, ON    K2G 6J8

                     
                                        EYES ON THE PATH           LES YEUX DU SENTIER

History
City of Ottawa - Pathway Patrol
Pathway Patrol was established in 1997 to provide information, improve safety and courtesy, and promote healthy living on Ottawa’s recreational pathways. Pathway Patrol is a City of Ottawa volunteer program working in partnership with the National Capital Commission.
 
Become a Pathway Patroller Greet pathway users. Provide assistance to pathway users. Remind users of pathway courtesy and regulations. Provide information about the pathway system. Promote safety and active living. Promote helmet use. Monitor pathways use and patrol activities.

FIRST AID AND CPR TRAINING
All Pathway Patrol volunteers must hold a valid Standard First Aid and CPR level C certification.
All courses are offered at the Ottawa Paramedic Service Training and Development Centre, 2465 Don Reid Drive.
Volunteer and get FREE Training!!

Patroller Requirements:
Applicants must meet the minimum requirements of: 18+ years of age. Complete Criminal Record Check (GREEN form). Complete Pathway Patrol training session. Standard First Aid and CPR Level C. Cyclists and in-line skaters must wear helmet. Able to commit to a minimum of 2 patrols per month. Must provide cell phone. Wear the Pathway Patrol Jersey while on patrol.

Sign-up today: Call us: 613-580-2854 Online: www.ottawa.ca/residents/volunteerservices Email us: pathwaypatrol@ottawa.ca


Pathway Patrol Volunteer Program

VOLUNTEER APPLICATION FORM

2012


Please check programme or service area you are most interested in:
(list your choices here and a brief explanation if desired)



Name:

Mailing Address:
                                (Apt. Number and Street)                                                             (City, Province)                                          (Postal Code)
Home Phone:                         Bus. Phone:                                 Fax #:                                  E-Mail Address:

Best time to contact you:

Your Age Category:
14 to 17 yrs.           18 to 65 yrs.        Over 65 yrs.    
                Note: In accordance with the “Occupational Health and Safety Act and Regulations for Industrial Establishments”,
                Volunteers must be a minimum age of 14 years.
                If you are under 18 years of age, please indicate your birth date:   __________            ___________          ________
                                                                                                                                     Day                        Month                         Year                    
Language(s) spoken:
                      m  English                          m French                          m   Other (please specify)
Do you have a valid driver’s licence?       m  Yes        m   No          m  Not applicable   Class of License ______________
Is this your first Volunteer Experience?  ¨  Yes   If no, please list your previous Volunteer Experience:


Work Experience/Present Occupation:

I prefer to volunteer with             Preschoolers:  m         Children:  m          Teens:  m               Adults:   m    
I prefer to volunteer with Seniors who are:     Alert   m             Frail    m                    Dementia    m      No preference   m                                       
Please indicate the time(s) that you are available to volunteer:
                Fall       Winter                               March Break           Spring                            Summer          All Year     
I am available:        Weekdays:   Mornings                       Weekday evenings                             Weekends  
                                                     Afternoons  
Please list any specific experience you have had with children, seniors, or disabled populations:


Please list skills, hobbies, musical talents, or interests you have that you might wish to share with others:



I heard about volunteering at  (insert your area here) from:

I want to volunteer at (insert your area here) because:



References: In the interest of client safety and to facilitate appropriate volunteer placements, all volunteers are required to submit two personal references. Individuals between 14 – 18 years will be asked to supply two letters of reference.
1.

                                (Name)                                                    (Relationship)                                                       (Telephone Number)
2.

                                (Name)                                                    (Relationship)                                                       (Telephone Number)
In case of emergency, the following contact information is required:

Name:                                                                                     Relationship:

Address:

Phone:                                                                                   

Are there any allergies, physical limitations, disabilities, medical or health conditions that we should be aware of?  Please specify


Would you be willing to be tested for tuberculosis, if required?       Yes   m   No   m  

Please indicate if you have received a Hepatitis B shot?                         Yes   m            No   m  
Would you be willing to receive a Hepatitis B shot, if required?      Yes   m   No   m

Would you be willing to receive a flu shot, if required?                    Yes   m   No   m
Have you ever been convicted of a criminal offence for which a pardon has not been granted?
                                Yes                      No         Comments: (if any):

As a potential volunteer for this position, will you agree to a check of your police record?
                                Yes                      No   

As a Volunteer, I fully understand and agree to the following.  PLEASE READ CAREFULLY BEFORE SIGNING
q  That except as authorized, during my service as a volunteer I will not use the City’s facilities and equipment, nor disclose, release or make use of any confidential or personal information that has been shared with, or acquired by me e except in accordance with my assigned duties as a volunteer.
q  That I will not receive any remuneration, salary, wage, payment or any employee benefits whatsoever, and I further understand that there is no employment relationship as a result of my volunteer activity.  Further I understand that the City may in its sole discretion reassign me or terminate my services as a volunteer, without notice or compensation.
q  That my volunteer activity may involve personal risk and could result in property damage or bodily injury. In the event of a claim arising out of my good faith performance of authorized volunteer activities for the City of Ottawa, the City of Ottawa will provide me with a legal defence and third party liability insurance coverage, subject to the conditions of the insurance policy.
q  With the exception of the types of claims set out in the preceding paragraph, I agree to indemnify and hold harmless the City of Ottawa, its employees, officials, and agents from all claims, demands, causes of action, losses, damages or costs arising from my actions as a volunteer, unless such claims, demands, causes of action, losses, damages or costs are attributable to my good faith performance of authorized volunteer activities.  I hereby release, waive, and discharge the City of Ottawa from all liability to my heirs, executors, administrators, assignees for all loss or damage and any claims or demands for such loss or damage on account of injury to person or property.
q  I understand that volunteers are not covered by the Ontario Workplace Safety and Insurance Act and that, as a result, I am not entitled to make any claims for compensation pursuant to the Ontario Workplace Safety and Insurance Act.  
q  I am aware of the nature and effect of the Release of All Claims and Waiver of Liability form that I am signing.  I acknowledge having read, understood, and agree to the above conditions, release, and waiver.  I certify that all statements made by me in this application, and any attached documents, are true and complete to the best of my knowledge and belief, and are made in good faith.
q     I hereby authorize the City of Ottawa to take my photograph or video and post it, or any part thereof, on the City public website or use through print or electronic media for the promotion of City programs and servicesI understand that the photograph or video will not be used by the City for any other purpose that those stated above without my written authorization.  I understand that the photograph may be downloaded, used, reproduced and/or altered without consent by unknown users of the City’s website and that this is beyond the City’s control.  I hereby release the City of any and all liability arising from such downloading, use, reproduction or alteration.


Yes____   No____,  I authorize Volunteer Services of the City of Ottawa to contact me to inform me of other City volunteer opportunities or special events.  I understand that Volunteer Services will not share my personal information with third parties. 


If under 18 years of age, a parent or legal guardian is required to sign:
q  I hereby certify that I am the parent/legal guardian of __________________________, a minor pursuant to the Age of Majority and Accountability Act and that s/he has my permission to serve as a volunteer with the City of Ottawa.  As the parent/legal guardian I fully understand and have full knowledge of the nature and extent of the risks involved with his/her participation as a volunteer.

______________________________________________         _______________________________________
Signature of Volunteer or Parent/Legal Guardian                                                         Date


Personal information contained on this form is collected under the Authority of the Municipal Act, 2001, S.O. 2001, c. 25, as amended, s. 10(3) para. 5. This information is collected for the administration and management of the City of Ottawa Volunteer Programmes.  Questions about the collection and use of this information should be directed to Coordinator, Volunteer Services, City of Ottawa, 110 Laurier Avenue West, Ottawa, Ontario. K1P 1J1. 580-2424 extension 28996.

Please attach your resume if it is current.


VERSION OF APPLICATION UPDATE:  August 24, 2006
List your name, phone number and e-mail address here.

FOR OFFICE USE ONLY


Date Interviewed:     ___________________________________________________________________________

Proposed Placement:  __________________________________________________________________________

Position:  ____________________________________________________________________________________

Supervisor responsible for placement:  _____________________________________________________________

Start date:  ___________________________________________________________________________________

Orientation date:  ______________________________________________________________________________

Comments:  __________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Follow-up:  __________________________________________________________________________________

Date and reason for leaving:  ____________________________________________________________________

Signature of Interviewer:  _______________________________________________________________________





VOLUNTEER AGREEMENT/RELEASE AND WAIVER FOR VOLUNTEER INVOLVEMENT WITH THE CITY OF OTTAWA (City Wide Sports, Pathway Patrol)

I, (please print) ____________________________________understand that I will be volunteering for the City of Ottawa, _________.Branch,at____________________for the specified period of_____________from______to___________only, and that during that time I will be under the direct supervision of a staff member from the City of Ottawa,_______Branch.

As a volunteer, I fully understand and agree to the following (please initial each box):
q  That I will not receive any remuneration, salary, wage, payment or any employee benefit whatsoever, or be covered by Workers’Compensation benefits.

q  That except as authorized, I will not use the City’s facilities and equipment or disclose or make any use of any confidential information.

q  That my volunteer activity may involve personal risk and could result in property damage or bodily injury.  Notwithstanding this acknowledgement, I hereby release the City of Ottawa from all claims for said damage or injury resulting from my participation as a volunteer, unless such damage or injury is caused by the negligence of the City of Ottawa.

q  That the City of Ottawa carries liability insurance, which would, subject to the conditions of the policy, cover me in the event of a claim arising out of my good faith performance of authorized volunteer duties for the City of Ottawa.

q  I hereby authorize the City of Ottawa to take my photograph or video and post it, or any part thereof, on the City public website or use through print or electronic media for the promotion of City programs and services.  I understand that the photograph or video will not be used by the City for any other purpose that those stated above without my written authorization.  I understand that the photograph may be downloaded, used, reproduced and/or altered without consent by unknown users of the City’s website and that this is beyond the City’s control.  I hereby release the City of any and all liability arising from such downloading, use, reproduction or alteration.

q  That should I wish to continue as a volunteer I agree to follow the intake procedure for becoming a volunteer with the City of Ottawa, ……….. Branch.  This includes completing an application form, providing two references, and undergoing a Police Records Check.

BY SIGNING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREED TO THE ABOVE CONDITIONS, RELEASE AND WAIVER.

If under 18 years of age, a parent or legal guardian is required to sign:
I hereby certify that I am the parent/legal guardian of __________________________, a minor pursuant to the Age of Majority and Accountability Act and that s/he has my permission to serve as a volunteer with the City of Ottawa.  As the parent/legal guardian I fully understand and have full knowledge of the nature and extent of the risks involved with his/her participation as a volunteer.

__________________________________________________________          __________________________
Signature of volunteer over the age of 18 (or Parent/Legal Guardian)                              Date

__________________________________________________________             ________________________
(Please Print: Address, City, Postal Code and Ward                                                          Phone Number       

_______________________________________
                          Email address

Personal information contained on this form is collected under the Authority of the Municipal Act        Municipal Act, 2001, S.O. 2001, c. 25, as amended, s. 10(3) para. 5. This information is collected for the administration and management of the City of Ottawa Volunteer Programs.  Questions about collection and use of this information should be directed to Coordinator, Volunteer Services, City of Ottawa, 110 Laurier Avenue West, Ottawa, Ontario. K1P 1J1, 613-580-2424 extension 28996.                                                                                                                                                                      
Form revised June 5, 2008