Please complete this application form if you are interested in becoming a Willing Helpers Medical Clinic volunteer. Once you complete the form, click the Continue button at the bottom.

Name and address

Demographic Information


Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

Skills, Training and Certifications


Please provide two personal or professional references