Thank you for your interest in assisting at our COVID-19 Vaccination Clinics!

Please note: This form is ONLY meant for those eligible to administer the COVID-19 vaccine through the Public ReadiĀ­ness and Emergency PreparedĀ­ness Act (PREP Act). All PREP Act volunteers must be registered with prior to applying to serve at Virginia Mason.

Questions? Contact Virginia Mason Volunteer Services at

Contact Information

Emergency Contact

In the event of an emergency whom should we notify?

Medical Experience

Please answer the following questions based on your current or past medical licensure.

Email Communication Agreement

I agree that Virginia Mason may use email to communicate with me regarding my COVID-19 Vaccine Clinic shifts and/or scheduling.