GIHW Flu 2021 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 where we held the drive thru flu shots clinic last year, 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 Marlene Dumpit, via email at mdumpit54@comcast.net or text/phone at (925) 819-0675.

For more information on our clinic, please visit http://gihw.org/e/flu2021/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/1Pr-HIjKMvIgndNtDEt-FGsmzpMaI66o3V-RA5BJYuNk/viewanalytics
Shift registration *
SELECT MULTIPLE/all you are able to attend. Morning: 9:45 AM to 12:15 PM, Afternoon: 11:45 AM to 2:15 PM.
None
Morning
Afternoon
SAT 10/09
SAT 10/16
SUN 10/17
SUN 10/23
SAT 10/30
SUN 10/31
SUN 11/14
SAT 11/20
SUN 11/21
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/flu2021/volunteering
Required
I have reviewed and agree to all the requirements to volunteer listed on gihw.org/e/flu2021/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 Marlene Dumpit for verification at mdumpit54@comcast.net
A copy of your responses will be emailed to the address you provided.
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