THERAPEUTIC RECREATION & LIFE SKILLS Student Placement Application Holland Bloorview Kids Rehabilitation Hospital 150 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 Information First Name: Last Name: School: E-mail Address: Type of Placement Placement 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 Community Programs Therapeutic Recreation (ages 7–14) Therapeutic Recreation (ages 15-21) Life Skills (ages 15-21) 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