CanCare - Volunteer Monthly Activity Report

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Volunteer Monthly Activity Report

* required fields

Volunteer's name:*

Month of:*

Year:*

Name of CanCare Referral

# of Visits:

# of Calls, Cards/Emails

# of Hours

Contact Has Ended***
(permananet end date)

***Giving a permanent end date for a referral means: that you do not plan to visit, call or contact the referral about matters pertaining to their cancer. In other words, they no longer need you as a volunteer and in support of their illness.

Non-CanCare Referrals/Contacts No Names Required	# of People	# of Visits	# of Calls	# of Hours

If any of these persons would like to be your official CanCare referrals please provide information in the section below.

New Referral Contact Information
(name, birthdate, address, telephone number, cancer type, date of diagnosis and any treatments, if available)

Additional Comments