All volunteers must register on this site to participate in the event. After registering, you may return to this site to change your clinic assignment, shift times, or other information.
Your registration information will not be saved until you complete all sections and click SAVE AND SUBMIT at the end of this form.
If your plans change in the future, please use the RECALL MY INFORMATION button to pull up your assignments, and cancel your registration promptly so that another may take your place..
We welcome medical, nursing, dental, and optometry student volunteers at Care Harbor.
Please read the following instructions carefully.
Note: If you are a healthcare student and will not be accompanied by a licensed faculty member, you can sign up as a General Volunteer and we will make every effort to place you in a support role in your professional area.
- Waiting Lists: if your preferred assignment is full, a waiting list option may be shown. If you choose to be on the waiting list for your preferred assignment, you will also be given the option to select an alternate assignment. If an opening becomes available in your preferred assignment, you will receive an email notice (and, if selected, a text message) automatically moving you to your preferred assignment. This will automatically cancel you from the alternate assignment.
CONFIDENTIALITY
I understand that while I am participating as a registered volunteer at the Care Harbor Free Clinic, it is mandatory that I maintain the privacy and confidentiality of all patients. This pertains to all present and future verbal, written and digital communications referring to any Care Harbor Free Clinic patients. I also understand that unless I am obtaining information strictly for patient registration, I shall not ask a patient any questions regarding health insurance coverage, Medicare, Medicaid or other coverage. I further agree not to photograph or record patients while at the Care Harbor Free Clinic.
RELEASE AND INDEMNIFICATION
I hereby release Care Harbor, a 501(c)(3) nonprofit entity, and all of its officers, directors, employees, agents, volunteers, contractors, heirs, successors and assigns (hereinafter the "Released Parties") from prosecution and presentation of any claim for bodily injury, damages, wrongful death or for property loss or damage incurred in connection with my attendance and/or performance of services at the Care Harbor Free Clinic.
I understand that I am volunteering at my own risk and that due to my occupational and/or other possible exposure to blood or other potentially infectious materials, I may be at risk of acquiring HIV, Hepatitis B or C virus, or other blood borne pathogens. I hold the Released Parties harmless in the event that I test positive for any such diseases as a result of my activities at the Care Harbor Free Clinic.
PHOTO RELEASE
I understand that film and video crews and photographers may be present at times during the event. I consent to being photographed, filmed, videotaped or recorded and grant my permission to use my image and likeness in any media for any lawful purpose in connection with Care Harbor or the Care Harbor Free Clinic without compensation to me. However, I reserve the right to refuse to be interviewed or to perform any action requested for purposes of photography, filming or videotaping unless I have given my express consent.
If I am volunteering to work as a healthcare professional providing patient care at the Care Harbor Free Clinic, I further agree to the following:
COMPLIANCE
I hereby attest that my license/certificate is currently in force and not restricted, suspended or revoked.
PATIENT-PHYSICIAN RELATIONSHIP
I hereby assert and agree that no patient-physician relationship will be established with any of the patients whom I treat, examine or consult with at the Care Harbor Free Clinic, and that any such treatment, examination or consultation shall not be sufficient to establish the contract - express or implied - that creates the patient-physician relationship. I understand and agree that patients attending the Care Harbor Free Clinic will expressly waive any claim to a patient-physician relationship.
With my electronic signature below, I acknowledge that I have read, understand and agree to all the terms of this Volunteer Agreement for the Care Harbor Free Clinic.