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Register to be a Covid-19 Vaccination Site Volunteer

  1. Register to be a Covid-19 Vaccination Site Volunteer

    Thank you for volunteering to share your time and talents to fight COVID-19. You are making a difference! You may need the following information or documents to complete your application.

  2. Clinical License (if applicable)-Criminal Background Check (Results Within Last 2 Years)-Resume-Volunteer Application

  3. Name

    Use your legal name, no nicknames

  4. Contact Information

  5. EXPERIENCE AND PREFERRED VOLUNTEER ROLES

  6. What are your preferred volunteer roles?*

    (You can select more than one)

  7. Have you had a state and federal criminal background check in the last 2 years?*

  8. You Availability *

  9. Will you help us test our plan by periodically responding to test emails and texts?

    As we wait for the vaccine to arrive, we will be testing our plans to make sure we are as prepared as possible. We will need to test our communication system and the response time of volunteers. You might receive test emails and texts that clearly state they are part of a test.

  10. Leave This Blank:

  11. This field is not part of the form submission.