JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Clinic Escort Interest Form
For over 35 years Abortion Action Missouri Foundation has facilitated the only Clinic Escort Program in the metro St. Louis area. Our program is designed to counteract the anti-choice protesters that attempt to harass and shame patients entering and exiting abortion clinics. Our volunteer clinic escorts walk patients into the clinics from their cars and vice versa as physical and emotional barriers to protesters. Legal Clinic Observers take on the vital task of observing and documenting protestor activities outside of the clinics.
If you're interested in becoming a clinic escort or a legal clinic observer, please fill out this form and we will contact you when our next training is scheduled.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Full Address
*
Your answer
Phone number
*
Your answer
Have you worked or volunteered with pro-choice organizations before? If so, please provide more information here. You may also include information regarding volunteer work at other progressive organizations (ACLU, Fight For $15, etc.).
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
