Volunteer Registration Form - H1N1 Flu Clinics
To register to help with the Jefferson County H1N1 Vaccination effort, please provide the following information and select the volunteer assignment and location that works best for your situation. You will receive an email containing your login information and a link to our scheduling website, from there you can sign-up for one or more volunteer opportunities. You will also receive a waiver, please print it out and bring it with you on your first day of volunteering.
Name and address:
Please provide the following contact information including at least 1 phone number and an email address.
First name:
*
Last name:
*
Street 1:
*
City:
*
Zip:
*
Home phone:
*
Cell phone:
Email address:
*
Password:
*
Confirm password:
*
Volunteer Assignment Selection:
Please choose the volunteer assignment and location that best suits your geographic location and abilities. Remember, this choice will determine what openings are available to you as a volunteer, so please choose an assignment and location that work for you.
For more information about a particular volunteer assignment and location please click on that specific link.
*
Assignment Preference:
Courts and Admin Building H1N1 Flu Clinic [Community Clinics]
Exit and Observation Group [Alameda High School]
Exit and Observation Group [Columbine High School]
Exit and Observation Group [Evergreen High School]
Greeting and Registration Group [Alameda High School]
Greeting and Registration Group [Arvada High School]
Greeting and Registration Group [Columbine High School]
Greeting and Registration Group [Evergreen High School]
JCPH Volunteer Nurse [Alameda High School]
JCPH Volunteer Nurse [Arvada High School]
JCPH Volunteer Nurse [Columbine High School]
JCPH Volunteer Nurse [Evergreen High School]
Lakewood H1N1 Flu Clinic [Community Clinics]
Sheriff Department H1N1 Flu Clinic [Community Clinics]
Staff Support Group [Alameda High School]
Staff Support Group [Arvada High School]
Staff Support Group [Columbine High School]
Staff Support Group [Evergreen High School]
Vaccination Support Group [Alameda High School]
Vaccination Support Group [Arvada High School]
Vaccination Support Group [Columbine High School]
Vaccination Support Group [Evergreen High School]
Volunteer Standards:
The volunteer agrees, represents, and warrants that:
1. I am competent to perform the volunteer duties assigned and will do so to the best of my ability and in a safe and reasonable manner.
2. I have read and agree to follow the description of my volunteer position.
3. I will follow the directions given to me by the Site Coordinator or any other Jefferson County Public Health (JCPH) or Visiting Nurses Association (VNA) representative.
4. I will not consume or be under the influence of alcohol or illicit drugs while performing volunteer duties for JCPH.
5. I will respect diversity and refrain from making offensive comments about race, gender, age, religion, physical ability, or sexual orientation. I will treat other volunteers, participants, etc., with respect and will use appropriate language. I will not sexually harass other volunteers and/or participants.
6. I understand that participant information is CONFIDENTIAL. I agree to protect the confidentiality of personal and medical information about participants.
7. I have completed the information on the Volunteer Registration Form and have signed it to acknowledge that I agree to uphold the volunteer standards.
I agree to the following:
I am 16 years or older.
I have clicked on the link of the volunteer assignment that I have selected and read the Duties and Qualifications. I am willing to accept the duties of the assignment and meet the qualifications described.
I have read and agree to uphold the volunteer standards set forth by JCPH.
Follow instructions from JCPH and VNA.
I Agree
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