Thank you for your interest in volunteering. We hope you will find this to be a rewarding and enjoyable experience. On behalf of the patients and community we serve, thank you for joining us! This site serves two purposes, to sign up new volunteers, and to allow registered volunteers to schedule additional volunteer opportunities and update any information. All of the fields you need to complete are on the page below. Your information will not be saved until you go to the very end of the page and click SAVE AND SUBMIT.
 
      If you previously registered on this webpage, we will recall your information.
Do not RECALL your information and type over it for another family member. That overlays the existing record.
 
 
Abbreviated Title   Example: Mr., Ms., Dr., Hon.
 
     
Professional Abbreviations       Example: DDS, MD, PhD
Name on Badge       List the information you want to appear on your badge.
Example: Dr. Jeff, Ms.King, Sam
 
 
  If possible, we would like to text you with occasional reminders and pertinent updates.
Mailing Address Line 1   Include apartment, suite or box number, if applicable.
Mailing Address Line 2  
 
 
 
  We recommend an email address unique to the registered volunteer instead of a shared office address or the personal address of a group leader for all group members. We will send personalized scheduling correspondence to this address.
 
        
  Establish your unique User Name. You may use your email address as your User Name unless another registered volunteer will be receiving correspondence at that same address. 
        
  Used to recall your information when you visit this site again so you can make changes and/or select additional volunteer opportunities.  Your password must be at least 6 characters.
 
       
Required Age
  I will be at least 18 years of age when I volunteer
  For legal reasons these are the age restrictions for volunteering.
 
T-Shirt Size   T-Shirt style is adult unisex.
Language Fluency (other than English)
Select all that apply
  Hold down the control key to select more than one language.
Hold down the control key and click on a selected language to de-select it.
         
Other Information
    Blood Borne Pathogen Certified     Have you taken the Red Cross blood borne pathogen certification training (or similar)?
    Vaccinated for Hepatitis B    
    Volunteer Overseas?
    If you are interested in volunteering for overseas disaster support operations please check this box and enter your general availability. We will put you on our mailing list.
    Computer Setup/Admin Proficiency     Are you able to configure Windows PCs, install software, setup Windows networking?
    Ice Skater     Just an example... you may add any number of your own questions.
          
Company / Organization   Optional, but helpful to know especially if you're coming with an office or team.
Matching
My company has a matching program
  Please indicate if your employer matches your donated time with a financial donation to the non-profit where you volunteer.
Description   Describe the program requirements and let us know how we can help - provide information for anyone we must contact and/or list any documentation you might need etc.
 
First and Last Name  
Relationship    
Phone    
   
Event Area
  Select the area appropriate to your profession / classification.
Profession / Classification
General Notes
(if needed)
 
License Number   Enter "none" if a license is optional for your profession and you do not have a license. Set the Expiration Date in the future.
Expiration Date    
Prof. Liability Insurance Carrier   Professional liability insurance is your responsibility.
State of Licensure   Only U.S. licensed professionals are able to volunteer as healthcare providers. Out-of-state providers MUST submit an attestation form to the WA State Department of Health in order to volunteer, click here for more information.
License Comment   List additional information we should know. Examples: You selected Other Professional - indicate field/specialty. Your license will renew before the clinic. You are licensed in a second field - provide license details.
     
Residency Location  
Residency Supervisor  
     

We welcome student participation, however student spaces are limited and students may be restricted in their type of involvement in patient care. The criteria for student participation also varies by discipline. Please follow the instructions below to determine if you are eligible to sign up in a student capacity.

  1. Look at the table to see if your field is listed. If it is, be sure you have indicated that student designation as your Profession/Classification in the section above. If your field is not listed, we encourage you to select the Profession/Classification "General Support" so you can still experience the clinic and contribute to serving people in need.
  2. If your field is listed, next look to see what year(s) of study we accept in a student capacity and whether you will need to arrange to have a supervisor be with you onsite. If your year of study is listed, in the Event section below select the assignment that shows that student designation (i.e. Dental Hygiene Student - All Years, Opticianry Student - 2nd Year). Or you can select any other assignment that is shown. If your year of study is not listed, select any of the assignments shown except the one with a student designation.
  3. If you are required to plan for an onsite supervisor, please use/enter that person's name and contact information in the Faculty Advisor fields above. Your supervisor must be a licensed faculty member from your school and will need to register individually as a Student Supervisor. If you do not arrange for a supervisor, or if your supervisor does not show up on the clinic day(s) when you volunteer, you will be reassigned to a General Support role. A supervisor may work with multiple students in one day.


Student FieldYear(s) of StudyOn-Site Supervisor Required
Dental Assisting StudentAllNo
Dental Hygiene StudentAllNo
Dental StudentAllNo
Dietician or Nutrition StudentDietetic Intern or Master's LevelYes, one will be assigned on clinic days
Massage Therapy StudentFinal YearNo
Medical StudentAllNo
Nursing StudentAllNo
Ophthalmology StudentFinal YearYes, try to plan your own for clinic days, otherwise we will assign
Opticianry Student2nd YearYes, one will be assigned on clinic days
Optometry StudentFinal YearYes, try to plan your own for clinic days, otherwise we will assign
Paramedic StudentAllNo
Pharmacy StudentInternNo
Psychology/Mental Health StudentGraduate LevelYes, must plan your own for clinic days
Public Health StudentAllNo
Social Work StudentMaster's Level 2nd YearYes, one will be assigned on clinic days
School    
Field of Study / Degree Program    
Year of Study    
Onsite Faculty Supervisor    
       
 
Event
  To sign up for multiple events, complete your entire registration and assignment selections for the first event and click SAVE AND SUBMIT at the end of the page. Then come back to choose a second event and make assignment selections. Again, you'll need to click SAVE AND SUBMIT to ensure its complete.
 
Event Location
---
  More detailed directions will be available prior to your arrival.
Event Email
---
  Please add this information to your safe senders/callers list.
Event Phone
---
 
Event Information
 
 
For each date below please select an assignment or "Not Attending This Day." If your preferred assignment is full, a waiting list option may be shown. If you choose to be on the waiting list for your preferred assignment (i.e. Dental Hygiene) you will also be given the option to select an alternate assignment (i.e. General Support). If an opening becomes available in your preferred assignment and you are assigned from the waiting list, you will receive an email notice of this change and a text message if you signed up for texting. If you also selected an alternate assignment, you will be automatically canceled from the alternate assignment.     
Admin Code
For administrative or instructed use only.
Day Type Assignment
   
     
   
[your name here] thanks you for volunteering. Each volunteer is required to read and sign this Volunteer Agreement and Liability Waiver as a condition of participating in the event.

By signing below, I, the undersigned volunteer, agree to provide services as a volunteer. As a condition of volunteering, I agree as follows:

1. I am donating my services and I am not entitled to any present or future salary, wages, or other benefits for providing these services.

2. I understand that the [your name here] provides limited reimbursement for an injury to a volunteer while providing volunteer services for our events and that the coverage is secondary to any other insurance I may have.

3. I understand I may be exposed to blood, bodily fluids and other potentially infectious materials that may contribute to the risk of acquiring HIV, Hepatitis B or other diseases. If I am exposed, or if there is a circumstance where I am the source of an exposure, I will immediately report the incident to [your name here]. I understand if I am exposed, [your name here] will provide initial blood test(s) at no cost to me and I agree to be tested if I am the source of an exposure. It is further understood that I am responsible for the cost of all subsequent tests, treatments and medical care.

4. I knowingly assume the risk of participating as a volunteer. In consideration of participating as a volunteer, I, for myself, my spouse, my legal representatives, heirs, and assigns, hereby forever unconditionally waive all claims (in law, equity, or otherwise) against [your name here], and their respective subsidiaries, affiliates, partners, officers, trustees, officials, employees, and agents, and volunteers, (collectively, "[your name here]"), arising out of my participation in these events.

Sign in the space below:
Please use your mouse to sign on a PC or use your mobile device touch screen
 
Thank you for registering as a volunteer. Upon clicking the SAVE AND SUBMIT button, you will be emailed a confirmation of your registration/updates.
   


        
       
   
       
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