THERAPEUTIC RECREATION & LIFE SKILLSStudent Placement Application

Holland Bloorview Kids Rehabilitation Hospital150 Kilgour Road, Toronto ON Canada M4G 1R8 T 416 425 6220 T 800 363 2440 F 416 425 6591 www.hollandbloorview.ca

A teaching hospital fully affiliated with the University of Toronto

Student InformationFirst Name:     

Last Name:     

School:     

E-mail Address:     

Type of PlacementPlacement Dates:       Number of Hours:      

Do you require a CTRS as a Supervisor? YES NO Are you a TRO Member? YES NO Are you available to work evenings and weekends? YES NO Do you have an up-to-date Criminal Reference Check? YES NO Are your immunizations up-to-date? YES NO

Please answer the following questions

What do you know about Holland Bloorview Kids rehabilitation Hospital and why are you a good fit with our organization?      

What are your learning objectives for this placement?      

Please rank your preference for placement area:Inpatient Rehab Programs

   Playroom (ages birth – 6)   Complex Continuing Care (ages 7-18)   Brain Injury Rehab Team (ages 7-18)   Specialized Orthopaedic Developmental Rehab (ages 7–18)   Persistent Pain Service (ages 12-18)

Community Programs

   Therapeutic Recreation (ages 7–14)   Therapeutic Recreation (ages 15-21)   Life Skills (ages 15-21)   Recreation and Equipment Loan

Do you have any additional comments?      

Thank you for your interest in a placement at Holland Bloorview Kids Rehabilitation Hospital, Therapeutic Recreation and Life Skills. Please answer the following questions and return this form along with your resume. Once this information is received you will be notified if you have been selected for an interview.