Public & Patient Engagement

Emergency Department Patient Advisory Council Application Form

All information on this form whether submitted online or in paper directly to the Winnipeg Regional Health Authority (WRHA) will be entered to a website owned by Volgistics, Inc. and not the WRHA. 

Volgistics is a third party contracted to manage and store all information on volunteers collected by the WRHA, including, but not limited to: this application, personal information, volunteer assignments, service hours, awards, etc.  Volgistics currently stores this information on servers located outside of Canada.  This information will be subject to the laws of the country where it is kept.

The WRHA are not responsible for any lost or misdirected data or for any delays while data is being sent to or stored on the Volgistics website.  Information about Volgistics' Security Features, Privacy Policies and Terms of Use can be found on its website at

Please note: Fields marked with a * are required fields

Mr. Ms. Mrs.
Name: *
Address (Please include Postal Code):

Phone (Home):

Phone (Work):

Phone (Other):

Email Address:

1. Why are you interested in being part of the Emergency Department Patient Advisory Council?

2. What do you think are the major issues that need to be addressed in emergency departments right now?

3. What experience, insights and perspectives do you feel you would bring to this advisory council?

4. What experience do you have participating on committees, boards, advisory committees, etc.

As we would like the opportunity to reflect the diversity of each community in membership on the Groups, you are invited to indicate if you are from any of the following groups: women, aboriginal people, visible minorities, and persons with disabilities:

How did you hear about the Emergency Department Patient Advisory Council?

Free Press
Community newspaper
Community organization
Health organization
TV or radio advertisement


Please provide the names of two people who could be contacted as references:

#1 Name/Address/Phone:

#2 Name/Address/Phone:


I hereby authorize the WRHA to contact the named references to ascertain my suitability as a volunteer.  I hereby release the WRHA from all liability for any damages whatsoever for obtaining and using same. 

By submitting this application, I agree that the information I have provided on the form is true and accurate. Furthermore, I understand and agree that submitting this application form does not automatically register me as a volunteer. It is the policy of WRHA Volunteer Services to screen all prospective volunteers. While we try to place every prospective volunteer, management reserves the right to decline applicants who do not meet our requirements and/or placement criteria. I consent to this information and information about my volunteer work with WRHA to be maintained on the Volgistics website and absolve and release the WRHA from all and any liability that may otherwise accrue by reason of keeping this information on the Volgistics website and using this information for WRHA purposes.

with the above disclaimer

Bookmark Email Print Share this on Facebook SHARE Share this on Twitter Tweet RSS Feeds RSS
Make text smaller Make text bigger
Traditional Territories Acknowledgement
The Winnipeg Regional Health Authority acknowledges that it provides health services in facilities located on the original lands of Treaty 1 and on the homelands of the Metis Nation. WRHA respects that the First Nation treaties were made on these territories and acknowledge the harms and mistakes of the past, and we dedicate ourselves to collaborate in partnership with First Nation, Metis and Inuit people in the spirit of reconciliation.
Click here to read more about the WRHA's efforts towards reconciliation

WRHA Accessibility Plan Icon
Wait Times
View the Winnipeg Health Region's current approximate Emergency Department and Urgent Care wait times.

View wait times
Find Services
Looking for health services in Winnipeg?

Call Health Links-Info Sante at 788-8200

Search 211 Manitoba

Explore alternatives to emergency departments at Healing Our Health System

Find a Doctor
Mobile App
Use your phone to find information about wait times and health services in Winnipeg. Download the Connected Care mobile app for iPhone today!

Learn more
Wave Magazine
The January / February 2019 issue of Wave, Winnipeg's health and wellness magazine, is now available online.

Read more
Contact Us
Do you have any comments or concerns?

Click here to contact us
The Winnipeg Health Region has a variety of career opportunities to suit your unique goals and needs.

Visit our Careers site
WRHA Logo Help| Terms of Use | Contact Us | En français