Thank you for your interest in volunteering to be part of the historic COVID-19 Community Vaccination efforts! The vaccination sites scheduled through this registration page are a partnership between the City of Seattle, Swedish and Virginia Mason Franciscan Health. Please note, this registration page does not encompass all vaccination sites offered by these organizations.

If your medical circumstances make you vulnerable to COVID-19, we recommend you DO NOT volunteer.

NEW TO THIS REGISTRATION SITE

1. Complete the form below if you have never done so previously.

2. Clinical roles are reserved for those with an active state license in good standing or authorized WAserv volunteers.

3. Non-clinical roles are performed by paid staff as well as volunteers.

4. If no assignments are available, please SAVE AND SUBMIT anyway so that your contact information is added to our roster and we can notify you when opportunities open.

RETURNING TO THIS REGISTRATION SITE

1. If you completed the registration form previously, click the red button RECALL MY INFORMATION. Enter your username and password.

2. You will be taken to a dashboard where you can click to UPDATE your personal information, REGISTER for a specific event, EDIT an existing event registration, or CANCEL your event participation entirely.

3. When you click to UPDATE, REGISTER or EDIT, the form will be repopulated with your information. Make updates, select when you want to participate and/or modify your selections, directly in the form.

PLEASE REMEMBER

1. Click SAVE AND SUBMIT at the end of the page to save your new or revised information.

2. Late cancellations and no shows impact our ability to provide vaccinations. If you must cancel, please give us as much advanced notice as possible by modifying your registration information.

 
      If you previously registered on this webpage, we will recall your information.
Do not RECALL your information and type over it for another family member. That overlays the existing record.
 
 
Abbreviated Title   Example: Mr., Ms., Dr., Hon.
 
     
Professional Abbreviations       Example: DDS, MD, PhD
Name on Badge       List the information you want to appear on your badge.
Example: Dr. Jeff, Ms.King, Sam
 
 
  If possible, we would like to text you with occasional reminders and pertinent updates.
Mailing Address Line 1   Include apartment, suite or box number, if applicable.
Mailing Address Line 2  
 
 
 
  We recommend an email address unique to the registered volunteer instead of a shared office address or the personal address of a group leader for all group members. We will send personalized scheduling correspondence to this address.
 
        
  Establish your unique User Name. You may use your email address as your User Name unless another registered volunteer will be receiving correspondence at that same address. 
        
  Used to recall your information when you visit this site again so you can make changes and/or select additional volunteer opportunities.  Your password must be at least 8 characters and contain at least one letter and one number. It may not contain the characters  < ' & * # .
 
       
Required Age
  I will be at least 18 years of age when I volunteer
  For legal reasons these are the age restrictions for volunteering.
 
T-Shirt Size   T-Shirt style is adult unisex.  Note that t-shirts may not be provided at all events.
Language Fluency (other than English)
Select all that apply 		  Hold down the control key to select more than one language.
Hold down the control key and click on a selected language to de-select it.
         
Other Information
    Vaccination Status     Are you fully vaccinated for COVID-19? Please upload proof of vaccination below.
          
Company / Organization   Optional, but helpful to know especially if you're coming with an office or team.
Matching
My company has a matching program
  Please indicate if your employer matches your donated time with a financial donation to the non-profit where you volunteer.
Description   Describe the program requirements and let us know how we can help - provide information for anyone we must contact and/or list any documentation you might need etc.
 
First and Last Name  
Relationship    
Phone    
   
Event Area
  Select the event area appropriate to your profession / classification.
Profession / Classification
General Notes
(if needed)
 
License Number   Enter your complete license, registration or certification information, including letters and numbers. Then, if authorized under the WAserv program, enter "PREP Act" in the License Comment box and upload your DOH authorization email below.
Expiration Date    
Prof. Liability Insurance Carrier   List your professional liability insurance company and policy number. If you do not have professional liability insurance, list PREP Act.
State of Licensure   An active WA license in good standing is required to work in a clinical capacity. WAserv volunteers authorized to provide COVID-19 vaccinations under the PREP Act are also accepted and must upload their DOH confirmation email below.
License Comment   List additional information we should know. Examples: You selected Other Professional - indicate field/specialty. Your license will renew before the clinic. You are licensed in a second field - provide license details.
     
Residency Location  
Residency Supervisor  
     
Please complete all of the fields below.
School    
Field of Study / Degree Program    
Year of Study    
Onsite Faculty Supervisor    
       
 
Limit Event List by State?   Select a state to limit the list to only events in that state.
Event
  To sign up for multiple events, make all of your assignment selections for the first event and click SAVE AND SUBMIT at the end of the page. Then come back to choose a second event and assignment selections. Again, click SAVE AND SUBMIT to ensure it is saved and complete.
 
Event Location
---
  More detailed directions will be available prior to your arrival.
Event Email
---
  Please add this information to your safe senders/callers list.
Event Phone
---
 
Event Information
 
 
For each date, select an assignment from the drop-down menu or indicate "Not Attending This Day." Be sure to scroll to the very end of the list to see all available assignments/shifts.

The time shown next to each assignment is the full shift, from check-in time to end time.

If assignments/shifts are not shown in the drop-down menu it means the positions as well as the waiting lists are currently full.

If you see WAITING LIST next to an assignment that means it is fully staffed. In this case you have 3 options:

1. Choose a different assignment.

2. Choose that assignment and be put on a waiting list. If you are only on the waiting list, you are not scheduled to participate unless an opening* occurs.

3. Choose that assignment and be put on a waiting list. Then select an alternate (ALT) assignment. In this case you are scheduled for the alternate assignment unless an opening* occurs in your waiting list assignment.

*If an opening occurs in your waiting list assignment, you will receive an email and text notice of this change and any alternate assignment will be automatically canceled.

    
Admin Code
For administrative or instructed use only.
Day Type Assignment
   
     
   
Select your profile picture   Upload a profile image (GIF, JPG or PNG), if desired.
Your current picture
   
Upload your proof of COVID-19 vaccination here, and type "COVID-19 Vax Proof" in the text box. If you are authorized to provide COVID-19 vaccinations under the WAserv PREP Act, save your confirmation email as a document named "PREP Act" and upload it here.
Document 1 Name      
Document 2 Name      
Document 3 Name      

No files have been uploaded
   

The COVID-19 Community Vaccination Sites are events of the City of Seattle in coordination with Swedish Health Services dba Swedish Medical Group (Swedish), Virginia Mason Franciscan Health and Seattle Center Foundation. Thank you for participating. Each volunteer is required to read and sign this Volunteer Agreement and Liability Waiver as a condition of participating in the events.

By signing below, I, the undersigned volunteer, agree to provide services to the Vaccination Sites as a volunteer. As a condition of volunteering, I agree as follows:


For All Volunteers

1. I am donating my services (“Vaccination Sites Services”). City of Seattle, Swedish, and Virginia Mason will follow the pay practices of their respective organizations. Unless otherwise stated, I acknowledge that I am not entitled to any present or future salary or wages for providing Vaccination Sites Services, and no one has made any promises to me regarding future employment or any other payments.

2. I am eighteen years of age or older.

3. I understand I may be exposed to blood, bodily fluids and other potentially infectious materials that may contribute to the risk of acquiring HIV, Hepatitis B, COVID-19 or other diseases. If I am exposed, or if there is a circumstance where I am the source of an exposure, I will immediately report the incident to Vaccination Site officials. I understand if I am exposed, that I may be responsible for the cost of all subsequent tests, treatments and medical care.

4. I knowingly assume the risk of participating as a volunteer for the Vaccination Sites. In consideration of participating as a volunteer for the Vaccination Sites, I, for myself, my spouse, my legal representatives, heirs, and assigns, hereby forever unconditionally waive all claims (in law, equity, or otherwise) against the City of Seattle, Swedish, Virginia Mason Franciscan Health, Seattle Center Foundation, Amazon, Neighborhood House and their respective subsidiaries, affiliates, officers, trustees, officials, employees, and agents, and volunteers, (collectively, "Vaccination Sites Parties"), arising out of my participation in the Vaccination Sites and my provision of Vaccination Sites Services. This Agreement does not constitute a waiver of benefits or burdens that may be applicable under the Washington Industrial Insurance Act (RCW Title 51).

5. I agree that I will not take any action, or omit taking any action, the result of which act or omission could be to waive the City’s immunity from liability under the PREP Act.

6. I also grant the City of Seattle and their respective agents the right to use, without payment or consideration of any kind, my picture, voice, and other reproductions of my physical likeness in connection with advertising or publicizing Vaccination Sites Services and activities in all forms of media in perpetuity.

7. I agree to notify Vaccination Site officials immediately if I am injured or if I become aware of any accident or injury to another volunteer or clinic participant.

8. I understand that Vaccination Site officials maintain the right to revoke my participation at any time with or without cause.

9. Volunteer positions may require a Washington State Patrol background check to volunteer for Vaccination Sites Services. I will either agree to the background check or I may decline to participate.

10. Volunteer positions require proof of being fully vaccinated for COVID-19 to volunteer for Vaccination Sites Services. I will either agree to provide this proof of vaccination or I may decline to participate.


For All Volunteers Accessing Confidential Information

In compliance with the federal and state privacy laws, I agree to hold in confidence all personal and protected health information I may overhear or come in contact with during and following the performance of Vaccination Sites Services. I further agree not to access, or remove from the premises, personal and protected health information or records unless relating to my performance of Vaccination Sites Services. It is understood that I shall be responsible for any direct or consequential damages resulting from my violation of this requirement.

As a condition of and in consideration of my use, access, and/or disclosure of confidential information, I understand and agree to the confidentiality requirements outlined in this Agreement. I understand that these requirements and my responsibility to protect the confidentiality and security of information apply when I am working off-site as well as at any owned and/or operated sites.

Confidential information may include, but is not limited to:

• Patient information (medical records, conversations, demographic information, financial information).

• Employee information (salaries, employment & payroll records, unlisted phone numbers, health records).

• Proprietary information (financial reports, production reports, report cards, reimbursement tables and contracted rates, strategic plans, internal reports, memos, contracts, peer review information, credit information, communications, computer programs, technology).

• Third party information (computer programs, vendor information, technology).

I will access, use and disclose minimum confidential information only as necessary to perform my role.

This means, among other things, that:

A. I will only access, use, and disclose the minimum confidential information as authorized to do this role;

B. I will not in any way access, use, divulge, copy, release, sell, loan, review, alter, or destroy any confidential information except as properly and clearly authorized within the scope of my role and in accordance with all applicable laws;

C. I will report to my shift supervisor or lead any individual’s or entity’s activities that I suspect may compromise confidential information.

Because all of my passwords (and/or other authentication devices such as tokens or cards) are the equivalent of my signature and because I am the only person authorized to use them, I agree to the following:

A. I will safeguard and not disclose my passwords or allow the use of my authentication devices by anyone including my manager or supervisor or another volunteer or staff member.

B. I will not request access to or use any other person’s passwords or authentication devices.

C. I accept responsibility to log out of the system to which I’m logged on. I will not under any circumstances leave unattended a computer to which I have logged on without first either locking it or logging off the workstation.

D. If I have reason to believe that the confidentiality of my password has been compromised, I will immediately change my password.

E. I understand that my password/or access will be deactivated in the event my role no longer requires use of the computerized system.

F. I understand that the Vaccination Sites have the right to conduct and maintain an audit trail of all access to patient information and other system activity such as internet access and the Vaccination Sites may conduct a review to monitor appropriate use of my system activity at any time and without notice.

G. I understand and accept that I have no individual rights to or ownership interests in any confidential information referred to in this agreement and that therefore the Vaccination Sites may at any time revoke my passwords or access codes.

I understand that it is my responsibility to be aware of these policies specifically addressing the handling of confidential information and that misconduct may result in loss of volunteer privileges.

I understand my obligations under this Agreement will continue indefinitely after leaving my role with the Vaccination Sites.


Special Provisions Applicable to Clinical Providers

If I am a clinical provider, I also agree as follows:

A. I represent that I have all necessary active licenses issued by the appropriate licensing authority which are required in order to provide treatment to patients and that I am not currently subject to any disciplinary action or investigation for criminal or professional misconduct in any jurisdiction.

B. I shall inform Vaccination Site officials if my license or disciplinary status changes.

C. I am responsible for performing the Vaccination Sites Services in a professional manner and in accordance with the standard of care and all applicable laws, rules, and regulations, including, without limitation, receiving a Hepatitis B vaccine.

D. If I am licensed in a United States jurisdiction other than Washington State, I agree to submit an attestation to the Washington State Department of Health at least ten (10) working days in advance of volunteering in Washington State.

E. I am responsible for the standard of care and quality of treatment I provide patients, and I am not subject to the supervision or control of the City of Seattle or the other Vaccination Sites Parties (as defined in 4 above). As a result, I agree that while I am donating my services to the Vaccination Sites, I will not be considered a volunteer under the direction of the City of Seattle or the Vaccination Sites Parties, and I agree that the provisions of Seattle Municipal Code 4.64.100 and .110 do not and shall not apply. I agree to defend, indemnify and hold the Vaccination Sites Parties (as defined in 4 above) harmless from all liability, claims, demands, losses, damages, action or judgments of every kind (including reasonable attorney’s fees) which may occur arising out of my treatment of patients and participation in the Vaccination Sites.

F. Any follow up treatment provided by me to a patient at a different location or after the Vaccination Sites dates is outside the scope of Vaccination Sites Services.

G. My acceptance of this agreement signifies that I give permission to the Vaccination Sites to verify the status of my license, my insurance, my proof of vaccination, and my background.


Provision Applicable to All Volunteers

By signing below, I represent that I am eighteen years of age or older, that I have read this agreement, including the release and waiver of liability, and fully understand its terms, understand that I will give up rights by signing it, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me, and intend my signature to be a complete and unconditional release of all liability.

Sign in the space below:
Please use your mouse to sign on a PC or use your mobile device touch screen
 
Thank you for registering as a volunteer. Upon clicking the SAVE AND SUBMIT button, you will be emailed a confirmation of your registration/updates.