service/volunteer information form

Please complete this form if you are interested in serving Stocked & Reddie & understand that:

UAMS CAN ONLY ALLOW VOLUNTEERS that are ACH & UAMS employees, UAMS students, residents, interns, FAMILY OF TeamUAMS & ACH employees, & UALR students ON CAMPUS AT THIS TIME.

Once you complete the form, click the 'CONTINUE' button at the bottom.

HOSPITAL AFFILIATION (VOLS LIMITED AT THIS TIME)

I verify I am a:

Name and Contact Information

First Name:

Last Name:

Preferred Name/Nickname:

Street 1:

Street 2:

City:

State:

* ZIP Code: *

Mobile/Cell phone:

* OK to call me here

Email Address:

Please enter a password that:

Is between 4 and 30 characters long

Password:

Confirm password:

Date of Birth:

Department / Division / College:

Would you like to opt-in to text messaging?

Yes Not now

Volgistics Volunteer Alerts sends reminders, alerts, and custom messages from System Operators and Coordinators. Use this section to opt-in and opt-out of text messaging (also known as "SMS"), and initially set how you would like to receive messages. Your messages can be delivered as emails, text messages, or none. You can change this at any time through VicNet. View supported phone carriers.

Mobile phone:

Country:

Receive automated
messages between:

and

Time zone:

Message and Data Rates May Apply. For help or information on this program send "HELP" to 28344. You can send "STOP" to 28344 at any time to opt out. For additional assistance, call 888-891-6978 or click here. Message frequency based on account settings. Messages are not guaranteed to be delivered. All messages will be sent by email until you respond "YES" to the welcome text message sent after the application form is submitted. Message preferences can be changed in VicNet on the Account tab.

Allow other volunteers to see when I am scheduled

Emergency Contact Information

First name:

Last name:

Cell phone:

* OK to call here

Relationship:

Service Commitment

IMPORTANT: I verify that I AM AN EMPLOYEE, STUDENT, RESIDENT, INTERN at AR Children's Hospital OR University of AR for Medical Sciences OR A FAMILY MEMBER of TeamUAMS or ACH employee.

I understand that UAMS CAN ONLY ALLOW VOLUNTEERS that are ACH & UAMS employees, students, residents, interns & their family members ON CAMPUS AT THIS TIME.

I agree to serve alongside others sharing the mission of Stocked & Reddie in a kind, safe, & efficient manner.

I Agree

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