North Cascade Cares Vision Clinic Registration (Health Professionals)-NCSDA

North Cascade Cares Vision Clinic Registration (Health Professionals)

Free Vision Clinic — October 20 & 22, 2023

Thank you for volunteering!

Our free vision clinic will be held at the North Cascade Seventh-day Adventist Church on October 20 and 22, with setup on October 19. Volunteers are needed in several different departments.

This form is for HEALTH PROFESSIONALS. If you would like to serve as a general volunteer, please visit this link to fill out a different registration form.

First name

Preferred Name (if different from your legal name)

Last name

E-mail

Phone Number

Address

Is there anything we should know about your department selections?

Are there any languages that you could provide translation for during the clinic?

When are you available to volunteer?

Thursday, October 19 (Setup)

Friday, October 20 (Clinic)

Sunday, October 22 (Clinic)

Sunday evening, October 22 (Tear-down)

Is there anything we should know about your availability to volunteer on the dates you selected?

Have you volunteered at a free vision clinic at this location before?

Yes

Please provide an Emergency Contact:

Emergency Contact Phone Number

If you are traveling in from out of town, would you like overnight lodging with a local volunteer in the area?

Yes

Upload either an image or document of your medical licensure.

Please make sure the uploaded information is readable.

Please select one

I have uploaded proof of licensure.

Medical licensure is not required for my position.

Volunteer Waiver of Liability

An insurance policy will be provided to cover personal and professional liability at our event. However, please read and acknowledge the statement below.

As a Participant Volunteer, I hereby acknowledge my awareness that my participation in Free Vision Clinic, held at the North Cascade Seventh-day Adventist Church (hereafter, "local church") shall be at the Participant Volunteer's own risk. The Washington Conference of Seventh-day Adventists, including the local church, administrators, officers, committee members, vendors and/or agents shall not be liable of any damages arising from personal injuries of damages sustained by Participant Volunteer in or during his/her active or passive participation at the Free Vision Clinic.

As a Participant Volunteer, I assume full responsibility for any injuries or damages, and hereby release and discharge, the Washington Conference of Seventh-day Adventists, including the local church its administrators, officers, committee members, vendors, and/or agents from any and all claims, demands, damage rights, or causes of action present or future resulting from participation in the Free Vision Clinic.

I have read and acknowledged the above statement.