Thank you for your interest in volunteering at Good Shepherd Clinic operated by Crossings Community Clinic! Crossings Community Clinic: Midtown thrives on the kindness and generosity of our volunteers. Start with prayer, and then take these next three steps to join the ministry.

1. Complete the appropriate form, click the submit button at the bottom.

2. After your application has been submitted, you will receive a confirmation e-mail with a link to the waiver and liability forms. Please bring these completed forms, along with any pertinent license (physicians, dentists, hygienists, nurses, administrative, DEA registration, etc) to the clinic.

3. Once you have completed the volunteer packet , your coordinator will work with you providing orientation and details about your assignment. Thanks again!!

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Demographic Information

Please provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

Gender:

Church:

Lifechurch member:

Emergency Contact

First name:

Last name:

Home phone:

Relationship:

Availability

Please indicate the days and times you are usually available to volunteer.

Email Preferences

Please use non-student e-mail address.
Use the checkboxes below to select the kinds of email you would like to receive from us.
*Please note that opting out of "Volunteer Opportunities" prevents Good Shepherd Ministries from sending your volunteer information to get started volunteering.

What kinds of email would you like to receive?

Volunteer Opportunities

*Includes Volunteer Login Information

Electronic Newsletters

Schedule reminders

Photo/Video Release

I authorize Good Shepherd Ministries, Inc. to use any photographs, images,or videos of me for a variety of purposes in any type of print, video, or digital media, including internet sites, without restriction. I agree that these images may be used without further notifying me. I understand that I will not be paid or rewarded for providing this authorization.

I Agree