Volunteer Monthly Report

Please fill out the required fields, enter any activy information and descriptions of contacts:

Month *

Year *

Volunteer Name *

Volunteer Email *

Worker Name *

Client First Name or Initials. Don't enter full name. *

Have you had contact with the client this month? *

Yes

No

Activity Information

Date +

Time Spent

Activity

Date +

Time Spent

Activity

Date +

Time Spent

Activity

Date +

Time Spent

Activity

Date +

Time Spent

Activity

Date +

Time Spent

Activity

Description of Contacts

1) PROGRESS IN COMPLETION OF GOALS:

2) AREAS OF POSITIVE OR CONCERNING HIGHLIGHTS

3) WHAT COULD THE AGENCY PROVIDE YOU WITH THAT WOULD HELP YOU ON THIS ASSIGNMENT?

I hereby give consent to:
• this information will be reviewed by the Volunteer department in the Family & Children’s Services of the Waterloo Region.

If you have finished completing the form, please check the box below. *

Complete

Family & Children's Services of the Waterloo Region
200 Ardelt Avenue
Kitchener, ON N2C 2L9
Phone: 519-576-0540 x3144
E-Mail:volunteer.services@facswaterloo.org