Thank you for your interest in volunteering at the Swedish Community COVID-19 Vaccination Clinic at Seattle University! By doing so, you play an important role in the historic COVID-19 pandemic recovery plan.

If your medical circumstances make you vulnerable to COVID-19, we recommend you DO NOT volunteer. Please continue to await your vaccination phase as defined by WA Department of Health.

NEW TO THIS REGISTRATION SITE

1. Complete the form below if you have never done so previously.

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. If no assignments are available, please SAVE AND SUBMIT anyway so that your contact information is added to our roster and we can notify you when we open additional opportunities.

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 click to UPDATE your personal information, REGISTER for a specific event, EDIT an existing event registration, or CANCEL your event participation entirely.

3. When you click to UPDATE, REGISTER or EDIT, the form will be repopulated with your information. Make updates, select when you want to participate and/or modify your selections, directly in the form.

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.

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.

First Name 

 

Last Name

 

Professional Abbreviations

Example: DDS, MD, PhD

Name on Badge

List the information you want to appear on your badge.
Example: Dr. Jeff, Ms.King, Sam

Contact Phone with Area Code 

 

Confirm Phone

 

Phone Type

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

 
 

State 

 

Zip Code 

 

Email Address

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.

Confirm Email Address

 

User Name

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. 
 

Password

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  < ' & * # .

Confirm Password

 
 

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.
 
 

Company / Organization

Optional, but helpful to know especially if you're coming with an office or team.

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 of Company Match

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 Volunteer Area

Select the area appropriate to your profession / classification.

Profession / Classification

 

General Notes


(if needed)
 

License Number

Please enter your complete professional license, registration or certification, including letters and numbers.

Expiration Date

 

Prof. Liability Insurance Carrier

List your professional liability insurance company and policy number. If you do not have professional liability insurance, list PREP Act. 

State of Licensure

An active or active retired WA license in good standing is required to work in a clinical capacity. WAserv volunteers authorized to provide COVID-19 vaccinations under the PREP Act are also accepted and must upload their DOH confirmation email below. 

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?

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 assignment from the drop-down menu or indicate "Not Attending This Day." 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.

Click here to read general information about volunteering at the clinic and descriptions of non-clinical roles.

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.
 
 
 
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 are authorized to provide COVID-19 vaccinations under the WAserv PREP Act, please save your confirmation email as a document named "PREP Act" and upload it here. Please DO NOT add any other documents in this section.
Document 1 Name:

Select file 1:
Document 2 Name:

Select file 2:
Document 3 Name:

Select file 3:

No files have been uploaded
 
Swedish Health Services thanks you for volunteering. Each volunteer is required to read and sign this Volunteer Agreement and Liability Waiver 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. I am donating my services and I am not entitled to any present or future salary, wages, or other benefits for providing these services.

2. 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 Swedish Health Services.

3. I knowingly assume the risk of participating as a volunteer.

Information Confidentiality Agreement:

As a condition of and in consideration of my use, access, and/or disclosure of confidential information, I understand and agree to the confidentiality requirements outlined in this Agreement. I understand that these requirements and my responsibility to protect the confidentiality and security of information apply when I am working off-campus as well as at Swedish including all owned and operated facilities and clinics.

Definitions

Confidential Information: Information which may include, but is not limited to:

• Patient information (medical records, conversations, demographic information, financial information)

• Employee information (salaries, employment & payroll records, unlisted phone numbers, health records)

• Swedish proprietary information (financial reports, production reports, report cards, reimbursement tables and contracted rates, strategic plans, internal reports, memos, contracts, peer review information, credit information, communications, computer programs, technology)

• Third party information (computer programs, vendor information, technology)


1) I will access, use and disclose minimum confidential information only as necessary to perform my role. This means, among other things, that:

a) I will only access, use, and disclose the minimum confidential information as authorized to do this role;

b) I will not in any way access, use, divulge, copy, release, sell, loan, review, alter, or destroy any confidential information except as properly and clearly authorized within the scope of my role and in accordance with all applicable laws;

c) I will report to my volunteer shift supervisor or lead any individual’s or entity’s activities that I suspect may compromise confidential information.


2) Because all of my passwords (and/or other authentication devices such as tokens or cards) are the equivalent of my signature and because I am the only person authorized to use them, I agree to the following:

a) I will safeguard and not disclose my passwords or allow the use of my authentication devices by anyone including my manager or supervisor or another employee.

b) I will not request access to or use any other person’s passwords or authentication devices.

c) I accept responsibility to log out of the system to which I’m logged on. I will not under any circumstances leave unattended a computer to which I have logged on without first either locking it or logging off the workstation.

d) If I have reason to believe that the confidentiality of my password has been compromised, I will immediately change my password.

e) I understand that my password will be deactivated in the event my role no longer require access to the computerized system.

f) I understand that Swedish has the right to conduct and maintain an audit trail of all access to patient information and other system activity such as Internet access and that Swedish may conduct a review to monitor appropriate use of my system activity at anytime and without notice.

g) I understand and accept that I have no individual rights to or ownership interests in any confidential information referred to in this agreement and that therefore Swedish may at any time revoke my passwords or access codes.


3. I understand that it is my responsibility to be aware of these policies specifically addressing the handling of confidential information and that misconduct may result in loss of volunteer privileges.

4. I understand my obligations under this Agreement will continue indefinitely after leaving my volunteer role with Swedish.

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.

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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