Thank you for your interest in volunteering at the UW Medicine COVID-19 Vaccine Clinics! We appreciate your support as we work together to end the pandemic.

If you have medical conditions that increase your risk of serious illness from COVID-19, we recommend that you DO NOT volunteer. Please follow the guidelines from the Washington State Department of Health to determine when you are eligible for the vaccine. See PhaseFinder for details.

NEW TO THIS REGISTRATION SITE

1. Complete the form below.

2. Clinical roles are reserved for those with an active state license. Clinical personnel with expired or out-of-state licensure are welcome to serve in non-clinical roles.

3. Even if no assignments are available, please complete your registration by clicking on Save and Submit at the bottom of this page. Your contact information will be added to our roster, and we will notify you when we schedule new events.

RETURNING TO THIS REGISTRATION SITE

1. If you completed the registration form previously, click the red button RECALL MY INFORMATION. Enter your username and password.

2. You will be taken to a dashboard where you can update your personal information, register for a specific event, edit an existing event registration, or cancel your event participation .

PLEASE REMEMBER

1. Click SAVE AND SUBMIT at the end of the page to save your new or revised information.

2. Late cancellations and no shows impact our ability to provide vaccinations. If you must cancel, please give us as much advanced notice as possible by modifying your registration information.

PLEASE NOTE

If you are a UW Medicine employee, please sign up to volunteer at a UW Medicine vaccination site that is in the same location as your home unit whenever possible. If there are shifts within the next week at another site, cross campus floating is permitted to assist with staffing shortages.

 
      If you previously registered on this webpage, we will recall your information.
Do not RECALL your information and type over it for another family member. That overlays the existing record.
 
 
Abbreviated Title   Example: Mr., Ms., Dr., Hon.
 
     
Professional Abbreviations       Example: DDS, MD, PhD
Date of Birth       required
Name on Badge       List the information you want to appear on your badge.
Example: Dr. Jeff, Ms.King, Sam
 
 
  If possible, we would like to text you with occasional reminders and pertinent updates.
Mailing Address Line 1   Include apartment, suite or box number, if applicable.
Mailing Address Line 2  
 
 
 
  We recommend an email address unique to the registered volunteer instead of a shared office address or the personal address of a group leader for all group members. We will send personalized scheduling correspondence to this address.
 
        
  Establish your unique User Name. You may use your email address as your User Name unless another registered volunteer will be receiving correspondence at that same address. 
        
  Used to recall your information when you visit this site again so you can make changes and/or select additional volunteer opportunities.  Your password must be at least 8 characters and contain at least one letter and one number. It may not contain the characters  < ' & * # .
 
       
Required Age
  I will be at least 18 years of age when I volunteer
  For legal reasons these are the age restrictions for volunteering.
 
T-Shirt Size   T-Shirt style is adult unisex.  Note that t-shirts may not be provided at all events.
Language Fluency (other than English)
Select all that apply 		  Hold down the control key to select more than one language.
Hold down the control key and click on a selected language to de-select it.
         
Other Information
  Birth State     What state were you born in? (Required)
  Gender     What is your gender? Type N/A if you prefer not to answer.
    I am a Firefighter    
    I am a UW Employee    
  Legal Name     What is your full legal name? (Required)
  Previous Names     Please provide any other names you have gone by in the past (including maiden name). Type N/A if you have none.
          
Company / Organization   Optional, but helpful to know especially if you're coming with an office or team.
Matching
My company has a matching program
  Please indicate if your employer matches your donated time with a financial donation to the non-profit where you volunteer.
Description   Describe the program requirements and let us know how we can help - provide information for anyone we must contact and/or list any documentation you might need etc.
 
First and Last Name  
Relationship    
Phone    
   
Event Area
  Select the event area appropriate to your profession / classification.
Profession / Classification
General Notes
(if needed)
 
License Number   Enter "none" if a license is optional for your profession and you do not have a license. Set the Expiration Date in the future.
Expiration Date    
Prof. Liability Insurance Carrier   Professional liability insurance is your responsibility. If your profession doesn't require it then just enter N/A.
State of Licensure   Only U.S. licensed professionals are able to volunteer as healthcare providers.
License Comment   List additional information we should know. Examples: You selected Other Professional - indicate field/specialty. Your license will renew before the clinic. You are licensed in a second field - provide license details.
     
Residency Location  
Residency Supervisor  
     
Please complete all of the fields below.
School    
Field of Study / Degree Program    
Year of Study    
Onsite Faculty Supervisor    
       
 
Limit Event List by State?   Select a state to limit the list to only events in that state.
Event
  To sign up for multiple events, complete your entire registration and assignment selections for the first event and click SAVE AND SUBMIT at the end of the page. Then come back to choose a second event and make assignment selections. Again, you'll need to click SAVE AND SUBMIT to ensure it is saved and complete.
 
Event Location
---
  More detailed directions will be available prior to your arrival.
Event Email
---
  Please add this information to your safe senders/callers list.
Event Phone
---
 
Event Information
 
 
FOR EACH DATE, SELECT AN ASSINGMENT FROM THE DROP-DOWN MENU OR CLICK "NOT ATTENDING THIS DAY" TO SEE AVAILABLE SHIFT OPTIONS.

Be sure to scroll to the very end of the list to see all available assignments/shifts. The time shown next to each assignment is the full shift, from check-in time to end time.

If you see WAITING LIST next to an assignment that means it is fully staffed. In this case you have 3 options:

1. Choose a different assignment.

2. Choose that assignment and be put on a waiting list. If you are only on the waiting list, you are not scheduled to participate unless an opening* occurs.

3. Choose that assignment and be put on a waiting list. Then select an alternate (ALT) assignment. In this case you are scheduled for the alternate assignment unless an opening* occurs in your waiting list assignment.

*If an opening occurs in your waiting list assignment, you will receive an email and text notice of this change and any alternate assignment will be automatically canceled.

    
Admin Code
For administrative or instructed use only.
Day Type Assignment
   
     
   
Select your profile picture   You may optionally upload a profile image. Just skip this option if you do not care to share an image. We accept GIF, JPG, and PNG images.
Your current picture
   
If you have been directed to upload a document of some kind please do so below. This is otherwise not necessary. new
Document 1 Name      
Document 2 Name      
Document 3 Name      

No files have been uploaded
   
UW Medicine thanks you for volunteering. Each volunteer is required to read and sign this Volunteer Agreement and Acknowledgment of Risk as a condition of participating in the event.

By signing below, I, the undersigned volunteer, agree to provide services as a volunteer. As a condition of volunteering, I agree as follows:

1. If I am a community volunteer, I understand that I am volunteering my services and I am not entitled to any present or future salary, wages, or other benefits for providing these services. This does not apply to UW Medicine employees who are picking up shifts at a UW Medicine vaccine clinic. UW Medicine employees will be paid the appropriate rate of pay for picking up shifts at a UW Medicine vaccine clinic.

2. I understand that UW Medicine will conduct a criminal background check and that I must provide a valid government-issued photo identification document (driver’s license or passport) and one of the following:

       a. A current picture identification card from a health care organization that clearly identifies professional designation

       b. A current license to practice

       c. Primary source verification of licensure

       d. Identification indicating that the individual is a member of a Disaster Medical Assistance Team (DMAT), the Medical Reserve Corps (MRC), the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), or other recognized state or federal response organization or group

       e. Identification indicating that the individual has been granted authority by a government entity to provide patient care, treatment, or services in disaster circumstances

       f. Confirmation by a licensed independent practitioner currently privileged by the hospital or by a staff member with personal knowledge of the volunteer practitioner’s ability to act as a licensed independent practitioner during a disaster

3. I understand UW Medicine’s expects volunteers to have a positive and supportive attitude towards its patients and staff and will use my best customer service skills while I volunteer.

4. I understand I may be exposed to blood, bodily fluids and other potentially infectious materials that may contribute to the risk of acquiring HIV, Hepatitis B, COVID-19 or other diseases. If I am exposed, or if there is a circumstance where I am the source of an exposure, I will immediately report the incident to the UW Medicine Employee Health Clinic at the facility where I have volunteered.

5. I acknowledge that there are certain risks inherent in participating as a volunteer and will report any incidents and accidents occurring in my assigned volunteer clinic, any work-related illness or injury, and any incidents that could have caused an injury or illness to my assigned supervisor as soon as possible. If I am injured, I will report to the Employee Health Services department or Emergency Department identified by my supervisor immediately for treatment. In the case of emergency, I give my consent for emergency medical treatment and understand that coverage of charges for that treatment being covered by Labor and Industries Insurance is contingent upon proof that I was a volunteer during the time that the emergency occurred.

6. I agree to follow infection prevention requirements for frequent hand washing or use hand sanitizer gel and will wear a mask at all times while I am volunteering.

7. I attest that I have been vaccinated against or have demonstrated immunity to measles, mumps, rubella, tetanus, diphtheria, pertussis, varicella, and influenza. I have also not been exposed to or have symptoms of tuberculosis.

8. I will agree to follow employee health requirements to not volunteer if I have any signs or symptoms of COVID-19 or other respiratory virus syndrome including fever, cough, difficulty breathing, malaise/fatigue, a new rash, unintended weight loss. I have reviewed the CDC COVID-19 symptom list available at click here for CDC symptoms list. I will attest that I have none of these symptoms each time I participate as a volunteer using the tools provided by my supervisor.

UW Medicine volunteers are personally responsible for ensuring the privacy and security of all patient, confidential, restricted, research data, student information or proprietary information to which they are given access (referred throughout as protected information). I also agree as follows:

• I will access, use, and disclose protected information only as allowed by my assigned duties and limit it to the minimum amount necessary to perform my assigned duties. I understand that my access will be monitored to assure appropriate use.

• I will maintain the confidentiality of all protected information to which I have access.

• I will only discuss protected information for reasons related to my assigned tasks and I will not hold discussions where they can be overheard by people who have neither a need-to-know nor the authority to receive the information.

• I will keep protected information out of view of patients, visitors, and individuals who are not involved in the patient’s care.

• I will use UW Medicine resources, including computers, only for my assigned duties or under conditions expressly permitted by UW Medicine.

• I will keep protected information taken offsite fully secured and in my physical possession during transit, never leaving it unattended or in any mode of transport (even if the mode of transport is locked). I will only take protected information off site if expressly approved by UW Medicine.

• I will not access my own protected information, or that of my friends, family members, or other individuals unless it is related to my assigned duties.

• I will protect access to information systems containing protected information:

       o I will commit my password to memory or store it in a secure place;

       o I will not share my password;

       o I will not log on for others or allow others to log on for me; and

       o I will not use my password to provide access or look up information for others without proper authority.

• I am accountable for all accesses made under my login and password, and any activities associated with the use of my access privileges.

• I will only use my own credentials in accessing patient accounts or other systems as provided to me for my assigned duties.

• I will log out or lock computer sessions prior to leaving a computer unattended.

• I will report all concerns about inappropriate access, use, or disclosure of protected information to UW Medicine Compliance (206-543-3098 or comply@uw.edu).

• Failure to comply with these standards may result in an end to my participation as a volunteer.

• My responsibilities involving protected information continue even after my separation from UW Medicine and I understand that it is unlawful for former volunteers to use or disclose protected information for any unauthorized purpose.

My signature below indicates that I have read, accept, and agree to abide by all of the terms and conditions of this Agreement and agree to be bound by it.
Sign in the space below:
Please use your mouse to sign on a PC or use your mobile device touch screen
 
Thank you for registering as a volunteer. Upon clicking the SAVE AND SUBMIT button, you will be emailed a confirmation of your registration/updates.
   


        
       
   
       
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