Remote Area Medical Volunteer Registration |
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Contact Information
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Abbreviated Title |
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Example: Mr., Ms., Dr., Hon., Mx. |
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Professional Abbreviations |
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Example: DDS, MD, PhD |
Date of Birth |
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required |
Name on Badge |
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List the information you want to appear on your badge.
Example: Dr. Jeff, Ms.King, Sam |
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If possible, we would like to text you with occasional reminders and pertinent updates. |
Mailing Address Line 1 |
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Include apartment, suite or box number, if applicable. |
Mailing Address Line 2 |
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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. |
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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. |
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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 < ' & * # . |
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Required Age |
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For legal reasons these are the age restrictions for volunteering. |
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Demographics and Background
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T-Shirt Size |
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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
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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. |
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Other Information |
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Company / Organization |
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Optional, but helpful to know especially if you're coming with an office or team. |
Matching |
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Please indicate if your employer matches your donated time with a financial donation to the non-profit where you volunteer. |
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Description |
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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. |
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Emergency Contact
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First and Last Name |
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Relationship |
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Phone |
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Profession or Volunteer Classification
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Event Area |
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Select the event area appropriate to your profession / classification. |
Profession / Classification |
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License Number |
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Enter "none" if a license is optional for your profession and you do not have a license. Set the Expiration Date in the future.
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Expiration Date |
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Prof. Liability Insurance Carrier |
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Professional malpractice insurance is your responsibility. Write "NONE" if you do not have any and reach out to RAM to learn more about being added to our insurance plan. |
State of Licensure |
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Out-of-state providers MUST follow the procedures for out of state volunteers. Only U.S. licensed professionals are able to volunteer as healthcare providers. |
License Comment |
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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. |
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Residency Location |
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Residency Supervisor |
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We welcome student participation at our clinics! We have three main types of student participation: - Pre-Health: If you are in a pre-healthcare track (pre-med, pre-nursing, pre-dentistry, etc.), please select "General Support" as your assignment. Since you are not a licensed medical professional, we could use your help as a General Support volunteer where your tasks may range from helping in patient registration to dental sterilization, depending on your interests and our needs at the clinic. We are excited for your to get some volunteer experience with us!
- In Professional School - No Supervisor Present: If you are in medical, nursing, dental, etc. school yet you do not have a licensed faculty supervisor accompanying you to the clinic, you will not be able to practice patient care at the RAM clinic. This means you will not be able to provide any medical services or treatments to our patients. You are welcome to sign up for your respective field's "Support" category. (i.e. Dental Support, Vision Support, Medical Support). This will allow you to assist the professionals in that clinic area by helping with patient flow, serving as a scribe to the licensed professional, etc. This is a great opportunity for your to gain shadowing experience or talk to professionals in the field you are studying while also helping the RAM clinic to run smoothly. Please fill out your school's information below.
- In Professional School - Supervisor Present: If you are in medical, nursing, dental, etc. school and you do have a licensed faculty supervisor that will accompany you to the clinic and if you are at least over halfway finished with your program and well into clinical rotations, then you will be able to practice patient care under your faculty's supervision. However, that supervisor must contact us at: volunteers@ramusa.org This is how our Volunteer Coordinators will provide the correct information, discuss the requirements, and approve your school for a specific clinic. Once you have been approved, you will be able to select a student assignment that will show up as your student type and your university ("Nursing Student - University of Tennessee"). Please fill out your school's information below.
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School |
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Field of Study / Degree Program |
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Year of Study |
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Onsite Faculty Supervisor |
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Limit Event List by State? |
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Select a state to limit the list to only events in that state. |
Event Category |
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This CATEGORY selection limits the events shown in the drop down EVENT list. |
Event |
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Signing up for more than one clinic? Great! Finish your registration and pick your assignments for your first clinic, then click SAVE AND SUBMIT at the bottom. THEN, click the RECALL button at the top to pull up your record, scroll down, and pick your assignments for the second event (and repeat). |
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Event Location |
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More detailed directions will be available prior to your arrival. |
Event Email |
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Please add this information to your safe senders/callers list. |
Event Phone |
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Event Information |
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Please select an assignment for each day you plan to attend. - Waiting Lists: if your preferred assignment is full, a waiting list option may be shown. If you choose to be on the waiting list for your preferred assignment, you will also be given the option to select an alternate assignment. If an opening becomes available in your preferred assignment, you will receive an email notice (and, if selected, a text message) automatically moving you to your preferred assignment. This will automatically cancel you from the alternate assignment.
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Assignment Specific Questions (If Any)
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Optional Profile Picture
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Select your profile picture |
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You may optionally upload a profile image. Just skip this option if you do not care to share an image. We accept GIF, JPG, and PNG images. |
Your current picture |
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Upload Volunteer Documents (if needed for your assignments)
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If you have been directed to upload a document of some kind please do so below. This is otherwise not necessary.
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No files have been uploaded
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Liability Waiver
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I hereby release and indemnify Remote Area Medical®, a non-profit organization, and all its respective officers, directors, agents, contractors, employees, heirs, successors and assigns from any claim for bodily injury or death or for property loss or damage incurred in connection with Remote Area Medical®, its missions or related activities. I also release and indemnify RAM for any claims against RAM by others as a result of my actions or inactions while volunteering for RAM, whether those actions are intentional or in negligence, and whether civil or criminal in nature. I fully understand that I am volunteering at my own risk regardless of the environment or services I am voluntarily performing for RAM. Additionally, but without limitation, I specifically release and indemnify RAM in relation to: 1. Any volunteer service I engage in which exposes me to blood or other potentially infectious materials putting me at risk of acquiring Hepatitis B virus (HBV) infection or other blood borne pathogens. I understand that if I do not have the HBV vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If, in the future, I want to be vaccinated with Hepatitis B vaccine, I can acquire the vaccination at my own expense; and, 2. The working environment at the RAM location where I volunteer which may take place near or involve working with or on heavy equipment and/or machinery, livestock, toxic materials, dangerous, and other potentially high risk activities. 3. I further hereby grant to RAM and its employees, directors, officers, agents, providers, and sponsors the right to use my picture, voice, or other reproductions of my physical likeness in connection with any advertising, publicizing or activities by RAM or any of its sponsors or Providers, in all media form, in perpetuity. COVID-19 Pandemic Notice and Acknowledgement of RiskThe World Health Organization has characterized the COVID-19 virus, also known as "Coronavirus," as a pandemic. RAM wants to ensure you are aware of the risks of exposure to COVID-19 associated with receiving treatment during this pandemic. COVID-19 is highly contagious and has a long incubation period. Individuals may have the virus, not show symptoms and yet still be highly contagious. COVID-19 can result in a life-threatening respiratory disease in some patients. You may be exposed to COVID-19 at any time or in any place. Due to the volume of individuals on site, the characteristics of the virus, and the characteristics of certain healthcare procedures, there is an elevated risk of you contracting the virus simply by being at a RAM clinic. Some procedures can create fine water spray or "aerosols" which may remain in the air for several minutes to hours. These aerosols may contain the COVID-19 virus and may create a risk of COVID-19 exposure. To provide a safe environment for our patients and staff, RAM follows the applicable state and federal regulations and protocols for infection control, universal personal protection, and disinfection. However, due to the nature of the procedures we provide, it may not be possible to maintain social distancing between patients, doctors, and staff at all times. Additionally, some of the safety measures being taken by RAM to prevent the spread of COVID-19 have been known to trigger allergic reactions or may be sensitive to your eyes or skin. Should you experience such during your presence in the RAM clinic, please notify a health care provider or other RAM professional volunteer. My signature below acknowledges my understanding of and agreement with the above release and indemnification and constitutes my waiver of all possible claims against RAM as well as those of any other persons or entities which could or may act or make claims on my behalf including, but not limited to, my attorneys, heirs, successors, agents, employees and other third parties, for any actions or claims that are or that may arise as a result of my service as a volunteer for RAM.
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Sign in the space below: |
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Please use your mouse to sign on a PC or use your mobile device touch screen
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Save and Submit - To Generate Confirmation
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Thank you for registering as a volunteer.
Upon clicking the SAVE AND SUBMIT button, you will be emailed a confirmation of your registration/updates.
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