Volunteer Registration
Vaccine Clinic Volunteer Sign Up
Hello and thank you for your willingness to help during our pandemic! Please fill out this form so that we will have basic contact information to reach out as we need help. Please be advised, we do not have vaccine in stock yet, and are only preparing for what we hope will be an opportunity to administer a lot vaccines in the quickly should the opportunity arise. We are unsure of the response to this sign-up, so please do not be offended if we do not contact you for help, as we have no idea how many vaccines we will receive at a time. For volunteers, we will mostly need help with directing people where to go, receiving paperwork, and documenting of vaccines given. For this reason, all volunteers will be required to do some health privacy training and more, just like you were an employee. Please be prepared for this assignment if you are selected to help! Thank YOU!
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Please tell us what days of the week you are available to volunteer. Please check all that apply.
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please describe a few words your qualifications that may be helpful in a vaccine clinic. Please note, you do not have to have health care professional experience, as we will also need clerks and greeters just like a voting station.
*
Submit Form
Should be Empty: