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UVOL Juneteenth Health/Wellness Outreach Volunteer Signup Form
Welcome! This form will be used to confirm your participation as a volunteer for U-VOL's Juneteenth Health & Wellness Outreach Event on Saturday, June 17th from 1:00 P.M. to 4:00 P.M. (Pacific Standard Time). If you have any questions, feel free to contact us at
volunteer@u-volfoundation.org
or
951-455-1324.
Please complete this form by Saturday, June 10th at 11:59 p.m. (Pacific Standard Time) if you are interested.
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Email
*
Your email
Name
*
Your answer
Phone Number
*
Your answer
Are you at least 18 years old or older?
*
Yes
No
Are you located in Southern California U.S.A?
*
Yes
No
Are you willing to refrain from smoking and/or drinking while volunteering in this event?
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Yes
No
Which one of the following volunteering activities most interests you?
*
Health Education
Vital Sign Screening
General Health Assessments
Nutritional Counseling
Required
Professional Title
*
(Example: MD, registered nurse, nurse practitioner, health educator, dietician, nursing/medical student, etc.)
Your answer
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