Form Centre • Hinton, AB • CivicEngage

Step One

Friendly Caller Resident Applicant
Telephone Check-ins to Reduce Isolation and Loneliness
“Volunteer’s do not necessarily have the time, they just have the heart.”
Elizabeth Andrew
Information and Application Package
Family and Community Support Services
821 Switzer Drive,
Hinton AB, T7V 1V1
Email: volunteer@hinton.ca Phone: 780-865-6036
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Resident Applicant Responsibilities

Section 1
Resident Applicant Responsibilities
Overall Duties and Responsibilities:
- A community volunteer is matched up with a Resident Applicant to provide a friendly chat strictly on a volunteer basis, and at no cost to the Resident Applicant.
- Volunteers place a call once a week on a set day and time, for approximately 15-30 minutes, to provide resident with a friendly ear, great conversation and ensure wellbeing.
- Both parties must have access to a reliable landline or cell phone.
- Please inform the Friendly Caller if you are unable to commit to your schedule.
- Please inform Family and Community Support Services if you choose to end your commitment entirely with the Friendly Caller Program.
- Promote and practice positive relationships with the Friendly Caller.
- Declare that you are reliable, trustworthy, and friendly.
- Commit to an ethic of confidentiality.
POLICIES
Gifting
Though, there are no concrete rules on gifting, you are discouraged from accepting gifts from the Friendly Caller as this is an unpaid, volunteer program.

Harassment and Abuse
Any form of harassment or abuse towards a Friendly Caller will be grounds for dismissal from the Friendly Caller Program and may be reported to the authorities, such as the RCMP.

These actions include but are not limited to:
- Verbal abuse
- Physical abuse
- Sexual abuse or harassment
- Neglect
Safety
In order to ensure you are safe, please limit this relationship to telephone calls only. Physical, in person visits are not a part of the Friendly Caller Program. If you require additional supports, please phone Family and Community Supports Services or call 211 for more information.
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Application

Applicant Information
First Name
Last Name
Address1
Address2
City
Province
Postal
Phone
Cell
Email
Emergency Contact
First Name
Last Name
Relation
Phone
Cell
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General Questions

Digital Signature

Please read and sign to verify your application:
I hereby state that to the best of my knowledge the information submitted on this application is true and accurate. I understand that I will be matched with a Friendly Caller.
Resident Applicant and Consent
Print Name
Re-Enter Name
Re-entering your name here serves as a digital signature confirming that you consent to have your information shared for the purpose of taking part in our Friendly Caller program.
Current Date
Current Date
Current Date
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Section 3

Resident Applicant Confidentiality Agreement
Confidentiality Policy
The Town of Hinton strives to uphold the highest standards of integrity. For this reason, it is the ethical responsibility of all program staff and volunteers to maintain the confidentiality of information obtained while participating in the program.

All personal information about the Friendly Caller while involved with the Friendly Caller Program will remain confidential during and after your involvement with the program.

Limits of Confidentiality
Certain information disclosed by program participants will fall outside the limits of confidentiality. The limits of confidentiality are as follows:
- 1. Confidential information may be shared with program staff and volunteers for the purpose of guidance and debriefing without consent from program participants.
- 2. Confidential information regarding any disclosure of abuse, self-harm or intended self-harm must be shared with staff and/or the appropriate authorities, such as the RCMP.
- 3. Confidential information may be shared between staff involved in the Friendly Caller Program in order to uphold program integrity.
Confidentiality Agreement
I understand that any personal information about others learned while participating in the Friendly Caller Program is of a confidential nature and is not to be shared unless required under the Limits of Confidentiality. Should I learn information regarding any form of abuse, self-harm, or intended self-harm towards another program participant, I will inform Family and Community Support Services and/or the appropriate authorities, such as the RCMP.

I agree to maintain client confidentiality during and after my involvement with the Friendly Caller Program and I understand that any breach of confidentiality could lead to my dismissal from the program
Resident Applicant Name
Resident Applicant Signature
Re-entering your name here serves as a digital signature and attestation to the above agreement.
Date of Signature
Date of Signature
Date of Signature
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Section 4

Waiver of Liability
I,
name
fully understand the risks associated
with participating in phone calls with a Friendly Caller. I agree that I will not hold the Town of Hinton, its staff, or the Friendly Caller responsible for any loss I should incur while participating in the Friendly Caller Program.
Re-enter name here as signature
Date of Completion
Date of Completion
Date of Completion
Thank You
Thank you for your application. You can now access our orientation package, available here.

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1. Receive an email copy of this form.
Email address

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Friendly Caller Resident Applicant

Steps

Step One

Resident Applicant Responsibilities

Application

General Questions

Digital Signature

Section 3

Section 4