Our Transitions Virtual Buddy Program offers fully vetted volunteers, who are excited to meet with Hamilton Extend-A-Family youth (ages 18-24) online.

CRITERIA:

Participation in this program requires that young adults have some computer skills, the technology and ability to engage in ZOOM meetings, and that the youth benefits from and enjoys online interactive socialization.

OUR VOLUNTEERS:

Our volunteers must submit both a current vulnerable sector clearance and three references that Extend-A-Family will contact. We also interview potential volunteers to determine their experience, education and current interests. Our volunteers are given training and are also scaffolded with ongoing support by EAF Staff. We attempt to match the volunteer’s interests with the participant’s hobbies and pursuits to create an ideal match that will develop into a long-lasting friendship. Our volunteers are committed to providing a minimum of one hour of online support per week by meeting with their “Buddy” to share fun activities.

WHAT WILL THEY DO?

Virtual Buddies engage in a variety of activities online. They read, dance, play games or just talk, depending on the youth’s interests. Our volunteers are provided with a variety of resources to interest and engage their Virtual Buddies. They also have access to crafting kits and art supplies that can be shared with a young adult to encourage creative time.

NEXT STEPS:

If this program sounds like a good fit, please complete and review the application form below.

VIRTUAL BUDDY TRANSITIONS PROGRAM APPLICATION FORM

Transitions Virtual Buddy Application

Name of Applicant *

Name of youth participant.

First Name

Last Name

Date of Birth *

Youths date of birth.

YYYY

Gender *

Please select from the drop down list.

Email of the youth participant.

Phone *

Youths phone number.

(###)

###

####

Address *

Address of youth participant.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Resides With *

Please select whom the participant resides with.

Mother

Father

Guardian

Other please explain:

Other

If "other" is selected above please explain whom the participant resides with.

Diagnosis *

Please select the youth participants diagnosis

Autism

ADD

ADHD

Downs Syndrome

FASD

OCD

ODD

PDD

Tourette's Syndrome

Other please explain:

Any other diagnoses?

Please list the youths additional diagnoses.

Is the registrant the primary contact? *

Is the person filling out the form the participant?

Yes

Primary Contact

Name of Primary contact (if not the participant).

First Name

Last Name

Primary contact relationship to the youth *

For example: parent, grandparent, social worker, or the participant.

Address

Primary contact address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Primary contacts phone number.

(###)

###

####

Mobile Phone

Primary contact mobile phone number.

(###)

###

####

Email *

Primary contacts email address.

Does the youth have any medical issues that may need to be monitored during a virtual visit? *

(example: seizures, mobility, or dietary restrictions)

Please share restrictions or guidelines for the youths online activities that the support person needs to be aware of:

Please share the youths interests and favourite activities to assist us with providing support that is unique to them: *

For example: loves funny movies, video games, reading, arts and crafts.

Technological Proficiency: On a scale of one to ten, with ten being the highest level, what level of technological comprehension best describes the youth's abilities: (How capable are they when using a computer?) *

LIABILITY WAIVER: By registering the youth participant of Hamilton and District Extend-A-Family. (“Virtual Buddy Program”), I agree to the following: The youth will be participating in the Virtual Buddy Program, discussions, chats and virtual workshops (collectively, the “Activities”) offered by Hamilton District Extend-A-Family. Some of these services will be delivered by Extend-A-Family staff and other support will be delivered by volunteers who have been screened through Vulnerable Sector Checks, personal reference checks and an initial interview. Screening is comprehensive but not exhaustive and may not discover all risks to the participant. *

I have read and agree to the statement

As a condition of the program activities the youth has engaged in, I, for myself, the youth, my executors and assigns, further agree to release and forever discharge Hamilton & District Extend-A-Family, its Board of Directors, officers, employees and volunteers from any claim that I might have myself or that I could bring on the youths behalf with regard to any damages, demands or actions whatsoever, including those based on negligence, in any manner arising out of the programs and activities that Hamilton & District Extend-A-Family has delivered. *

I have read and agree to the statement

The Staff and Volunteers of Extend-A-Family are required to sign a confidentiality agreement prior to working with families and will ensure that your privacy is maintained, with the following exceptions: • They are required by law to report any incident of perceived child abuse • They are required by law to report any indication that a person intends to harm themselves or others • Staff and volunteers will respectfully discuss familial information that is relevant to providing the best client centered support possible

The participant will not be under the influence of recreational drugs and alcohol during the program *

I have read and agreed to this statement

Information regarding the participant will only be shared with Contact Hamilton or other agencies having a relevant interest in their well-being, with the utmost discretion. Such correspondence will be documented and copied to the participant, parent, or guardian. Do you give consent to Hamilton & District Extend-A-Family to share information about this individual with professionals from other agencies? *

Yes

I grant Hamilton & District Extend-A-Family consent to use photographs or video footage taken by agency staff or volunteers to promote our agency via internet, social networking sites, agency newsletters, brochures, and other media: *

Yes

I have read this entire waiver and permission form, fully understand it, and agree to be legally bound by its terms. Participants release Hamilton Extend-A-Family, the board, employees and volunteers of all liability regarding 1) any injury to self or others and 2) any loss or damage to personal property. *

I have read and agree to the statement

Name of Parent, Guardian, or Participant. *

First Name

Last Name

Date of Application *

YYYY

Electronic Signature: By placing my name I acknowledge that I am electronically signing this document. I am signing this Agreement freely, voluntarily and competently and am at least eighteen (18) years of age and I am the Adult Participant, Parent or legal Guardian of the participant. I Certify that I have carefully examined this entire Waiver form and I determined that to the best of my knowledge and belief, the information provided is complete and accurate. *

Notes:

Thank you! Once we have reviewed your application an EAF team member will reach out to you (typically within 1-2 business days).

In-House Programs Pre-Screening Form

All participants must complete a pre-screening survey online each time prior to attending our programs. Participants will not be permitted to join in-person events until a parent/guardian has successfully completed the survey.

Name of Participant *

First Name

Last Name

Age of Participant *

Name of Parent or Guardian *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best telephone number to reach you in the event of an emergency *

Permission to collect information electronically *

Yes

Have your child or anyone in your household felt hot or feverish in the last 10 days? *

Yes

Do you or anyone in your household have any of these symptoms: New or worsening cough? New or worsening shortness of Breath? Difficulty breathing? Sore throat or painful swallowing? Runny nose? *

Yes

Has your child had any symptoms of MIS-C including: Fever that lasted 24 hours or longer? Vomiting? Diarrhea? Pain in the stomach? Skin rash? Red eyes? Redness or swelling of the lips and tongue? Feeling unusually tired? Redness and/or swelling of the hands or feet? Headache that’s unusual or long lasting? *

Yes

Have you experienced a recent loss of smell or taste? *

Yes

Have you been in contact with any confirmed COVID-19 positive patients, or persons self-isolating because of a determined risk for COVID-19? *

Yes

Have you returned from travel outside of Ontario in the last 14 days? *

Yes

If you answered "yes" to travelling outside of Ontario - where did you travel to?

Is your workplace or the workplace of anyone in your household considered high risk? *

Yes

I give permission for my child/teen named as above to attend Hamilton & District Extend-A-Family events recognizing that there is potential risk in in-person events despite the precautions taken. *

Yes

Signature of Parent or Guardian *

Date of Signature *

YYYY

Thank you for Completing the Programs Pre-Screening Survey!

Please note: Participants will be asked to have their temperature checked using a contactless thermometer prior to entry.

Donate Now

Hamilton & District Extend-A-Family, 2-1022 Barton Street East, Hamilton, ON, L8L 3E4, Canada905-383-2885eaf@execulink.com

Send Mail to: 2-1022 Barton Street East, P.O. Box 47578, RPO Centre Mall, Hamilton ON L8H 7S7

ALL ARE WELCOME!

Hamilton & District Extend-A-Family welcomes individuals of all genders, sexualities, and racial backgrounds.

Registered Charitable Number 11895 1557 RR0001

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