Please complete this registration form to complete account set up for our VicNet system. You will use VicNet to sign up for shifts, and view your schedule. Once you complete the form, click the Continue button at the bottom. After submitting your registration form, you will be able to access our homepage, which will include additional instructions based on the type of role you are interested in supporting. You will be asked to sign paperwork and return to VaccineVolunteer@stlouisco.com. If you are interested in clinical roles, you will be additionally asked to complete an online training prior to submitting paperwork.

Contact Information

First name:

Last name:

Street 1:

City:

State:

Zip:

Cell phone:

Email address:

Volunteer Role

Please select which volunteer role aligns best with your qualifications. At this time, one of the following licensures is required to be a vaccinator and operate under standing orders: LPN, RN, NP, PA, MD, paramedic pharmacist with immunization training. EMTs may assist in the vaccine monitor role, but cannot vaccinate.

Preferred Role:

Credentials and Prescreening Information

All volunteers will be asked to submit signed paperwork in advance of scheduling any volunteer shifts. After submitting your registration form, please sign into your account and review the instructions on our homepage.

License:

BCR Certification

Please indicate if you have a current certification in basic cardiopulmonary resuscitation or more advanced certification. This will be used for appropriate allocation of medical volunteers and staff at each vaccination site and shift.

Basic Cardiopulmonary Certification:

Affilliation

Please select your affiliated university, if applicable

University:

Availability

Please indicate the days and times you are usually available to work

My availability is:

From:

to:

I would like to serve up to:

hours:

Messaging opt-in

We send all important alerts and updates regarding volunteer schedule changes through VicNet messaging. Please select "yes" for all forms of message preferences below in order to receive important updates about changes to your upcoming scheduled shifts or urgent volunteer notifications.

Please understand that by not checking the "agree" box, I may fail to receive important communications and alerts

VicNet Password

We provide an online "Volunteer Information Center" (VicNet) where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Volunteer Information Center.

Please enter a password that:

Is between 8 and 30 characters long
Contains both letters and numbers.
Contains a combination of both uppercase and lower case letters.

Password:

Confirm password:

Messaging opt-in

I agree to opt-in to all messaging notification types in order to receive important updates about my scheduled shifts. I understand that by not checking the "agree" box, I may fail to receive important communications and alerts

I Agree