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Patient and Family Advisor Application

Patient and Family Advisor Application

 

 

Patient and Family Advisor Application

Please list two (2) non-family reference we may contact:

If under 18 years of age, we require parental/ guardian consent for application. 

I understand that my child named in this application wishes to be considered for volunteer work and I hereby give my permission for them to serve in that capacity, if accepted by the Chatham-Kent Health Alliance. I understand that they will be provided with orientation and training necessary for the safe and responsible performance of their duties and that they will be expected to meet all the requirement of heir position, including regular attendance and adherence to Alliance polices and procedures. I understand they will not receive monetary compensation for their services contributed.

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Chatham Campus

Chatham Campus

80 Grand Avenue West
P.O. Box 2030
Chatham, ON N7M 5L9

Sydenham Campus

Sydenham Campus

325 Margaret Ave
Wallaceburg, ON N8A 2A7

1.519.352.6400