GIHW Flu 2022 Volunteer Registration
Thank you for expressing interest in volunteering with us, the Global Initiative for Health and Wellness and Samaritan House of San Mateo, at our annual series of Flu Vaccination Clinics.

Our clinic is located at 19 W 39th Ave. Ste. #5, San Mateo, CA 94403. This is NOT the main Samaritan House location where food distribution is given, but a few blocks north on El Camino Real. For directions, click here: https://goo.gl/maps/Tb8dk261vwwuo5ib6

You will receive an email with a copy of your responses to this form. This email should also contain a link where you can edit your response, if you need to change your shift selection.

ALL INFORMATION ENTERED ON THIS FORM SHOULD BE CONSIDERED PUBLICLY ACCESSIBLE. If you have any sensitive details or questions, please instead direct those to our volunteer coordinator, Lion Eleanor Britter at estjohn7@gmail.com.

For more information on our clinic, please visit http://gihw.org/e/flu2022/volunteering.
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Email *
First Name *
Last Name *
Phone Number
Optional: Again, please remember any information entered here should be considered publicly accessible
Affiliated Club/Organization *
Editing Your Submission
You will receive an email confirmation with your selection, which includes a link to modify your submission if necessary. View existing registrations here: https://docs.google.com/forms/d/e/1FAIpQLScFRYSvXNMULIWUZjKizKP5vBehI2C7SAICYuSZywIfVW3BJw/viewanalytics
Shift registration *
Select all dates you are planning to attend. IF YOU HAVE FILLED OUT THIS FORM IN THE PAST (FOR THIS YEAR), DO NOT SUBMIT A DUPLICATE ENTRY. Check your email for your original submission, which should contain a link to edit your selection.
NO
YES
10/8 Saturday 10 am – 2 pm
10/9 Sunday 12 noon – 4 pm
10/14 Friday 4 pm – 6 pm
10/15 Saturday 10 am – 2 pm
10/16 Sunday 12 noon – 4 pm
10/21 Friday 4 pm – 6 pm
10/22 Saturday 10 am – 2 pm
10/23 Sunday 12 noon – 4 pm
10/29 Saturday 10 am – 2 pm
10/30 Sunday 12 noon – 4 pm
11/5 Saturday 10 am – 2 pm
11/6 Sunday 12 noon – 4 pm
11/9 Wednesday 4 pm – 6 pm
11/10 Thursday 4 pm – 6 pm
11/12 Saturday 10 am – 2 pm
11/13 Sunday 12 noon – 4 pm
11/16 Wednesday 4 pm – 6 pm
11/17 Thursday 4 pm – 6 pm
11/19 Saturday 10 am – 2 pm
11/20 Sunday 12 noon – 4 pm
Notes
Feel free to include any notes you may have (regarding availability, accessibility needs, if you're signing up for a partial shift/need to leave early or come late on certain days, etc). ALL NOTES WILL BE PUBLICLY ACCESSIBLE. Again if you have any details you'd like to discuss privately, please email Lion Marlene Dumpit directly.
Role *
If you have not worked with us in the past, select all that you are able/willing to do. (Of course, if you already know what you're assigned, pick that only.) Role descriptions can be found at http://gihw.org/e/flu2022/volunteering
Required
I have reviewed and agree to all the requirements to volunteer listed on http://gihw.org/e/flu2022/volunteering *
(1) Volunteers must be fully vaccinated against COVID-19. Verification will be required the first time you volunteer with us. A digital record of your vaccine card can be obtained at https://myvaccinerecord.cdph.ca.gov (if vaccinated in California) (2) Per San Mateo County Health Orders, all persons at our indoor clinic must wear a well fitting mask/face covering. (3) If you have experienced any of the symptoms of COVID-19 within 24 hours prior to your shift, we ask that you notify us to cancel/reschedule your shift. (4) Medical professionals only: Current medical licence number should be provided to Lion Eleanor Britter at estjohn7@gmail.com
A copy of your responses will be emailed to the address you provided.
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