CanCare - Become a Volunteer

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Volunteer details

* required fields

Today's date:*

Were you a CanCare client:*

Yes
No

Where did you learn about CanCare?:

First name:*

Last name:*

Spouse's name (if applicable):

Date of birth:*

Languages spoken (other than English):

Children:

Yes
No

If you have children, please list the number of children and their ages:

Home phone:*

Cell phone:

Office phone:

Email:

Home street address:*

Home city:*

Home state:*

Home zip code:*

Place of employment:

Job title:

Business street address:

Business city:

Business state:

Business zip code:

Education and work experience:*

Special interests, talents and/or skills:*

I am a cancer survivor.

I am a caregiver.

When were you or the person you cared for diagnosed with cancer?:

Type of cancer:

Metastasis:

Name of primary cancer physician:

Type of cancer treatment:

If chemo, what have you taken?:

If surgery, what type?:

Radiation:

Yes
No

Other treatment?:

Currently under treatment:

Yes
No

If yes, what kind?:

Reason for volunteering (in brief):

Your congregation's name/address (if applicable):

Pastor/Rabbi:

Pastor/Rabbi phone:

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A training fee of $25 per person or $40 per couple is set by our Board to cover the cost of training materials and refreshments. This fee can be paid at the time of the interview. Scholarships are available for those in need.

Upcoming events and training