Thank you for your interest in the Seattle/King County Clinic. Caring for people in need in such a large-scale health clinic is only possible because of people like you. We hope you will find this to be a rewarding and enjoyable experience!

NEW PARTICIPANTS

1. Complete the form below if you have never done so previously. We will not sell or share your information with sources outside of the Clinic.

2. If no Clinic events are open for registration, complete all information except the EVENT section to be added to the volunteer roster. You will be emailed when Clinic events are scheduled.

RETURNING PARTICIPANTS

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 serve patients. If you must cancel, please give us as much advanced notice as possible by modifying your registration information or contact us directly at SKCClinic@seattlecenter.org or 206-615-1835.

 
      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., Mx.
 
     
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 old 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
    Bloodborne Pathogen Education/Training     Available through redcross.org
    Computer Proficiency - Intermediate or Greater    
    Dietary Restriction - Gluten Free    
    Dietary Restriction - Vegan    
    Dietary Restriction - Vegetarian    
    Healthcare Office or Operations Experience
    If you are not a licensed healthcare professional, briefly describe experience in comment box.
    Member of Public Health Reserve Corps (Seattle & King County ONLY)
    Indicate your Seattle & King County PHRC ID number in comment box.
    Vaccinated for Hepatitis B    
          
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 license, registration or certification number, whatever type is relative to your profession. Include both letters and numbers.
Expiration Date    
Prof. Liability Insurance Carrier   You MUST have malpractice insurance. List insurance co. and policy #. Click here to learn about requirements. U.S. licensed providers can apply for free coverage here .
State of Licensure   Only U.S. licensed professionals can volunteer as providers. Out-of-state providers MUST submit a Dept. of Health attestation form at least 2 weeks before clinic starts. Click here for the online form.
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  
     

We welcome student participation, however student spaces are limited and students may be restricted in their involvement with direct patient care. The criteria for student participation varies by discipline. Students must be currently enrolled in a clinical program. Follow the instructions below to determine if you should select a "Student" Profession/Classification. Otherwise, use the classification "General Support" (this is also what pre-health majors should select.)

  1. Look at the table to see if your field and year of study is listed. If it is, select that student designation as your Profession/Classification. If your field and year of study is not listed, select the Profession/Classification "General Support" instead so you can still experience the clinic and help people in need.
  2. If your field and year of study is listed, next look to see if you need to have a faculty supervisor.
  3. If you are required to have a supervisor, that person must be a licensed faculty member from your school and will need to register individually. Supervisors for graduate level students may be able to participate remotely. If you do not have a faculty supervisor, or if your supervisor does not show up on the clinic day(s) when you volunteer, you will be reassigned to a General Support role. A faculty supervisor may work with multiple students in one day.

  4. Contact SKCC organizers at 206-615-1835 or skcclinic@seattlecenter.org for more information or to arrange faculty supervision.


Clinical ProgramYear in ProgramSupervisor Required
Dental Assisting1st - 2nd YearIn some instances
Dental Hygiene1st - 4th YearIn some instances
Dental1st - 4th YearIn some instances
Dietician or NutritionIntern or Graduate LevelYes
Medical1st - 4th YearNo
Nursing (RN)1st - 4th YearIn some instances
Opticianry1st - 2nd YearNo
Optometry1st - 4th YearNo
PharmacyInternNo
Physical Therapy2nd - 3rd YearNo
Psychology/Mental HealthGraduate LevelYes
Social WorkMaster's Level 2nd YearYes
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, complete your entire registration and assignment selections for the first event and click SAVE AND SUBMIT. Then come back to choose a second event and make assignment selections. Again, click SAVE AND SUBMIT to ensure its 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." The time shown next to each assignment is the full shift length, from check-in time to end time. We are planning on your participation for that entire time.

If you see the term “Waiting List” next to an assignment name that means it is currently full. In this case you have 3 options:

1. Choose a different assignment.

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

3. Choose that assignment and be put on a wait list. Then select an alternate assignment. In this case you are scheduled for the alternate assignment unless an opening* occurs for your wait-listed assignment.

*If an opening becomes available in your wait list assignment and you are moved into it, you will receive an email notice of this change and any alternate assignment will be canceled.

If you select an assignment that includes "As Assigned" in the name, organizers will assign/place you where they need you most in advance of the event or onsite during the event.

Click here to review assignment descriptions for each area.

The drop-down menus list assignments chronologically by start time. Be sure to scroll to the end of the list to see all options available to you.

    
Admin Code
For administrative or instructed use only.
Day Type Assignment
   
     
   
Select your profile picture   Upload a profile image, if desired. We accept gif, jpg, and png images.
Your current picture
   
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Document 2 Name      
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The Seattle/King County Clinic (“SKC Clinic”) is a joint event of the Seattle Center and Seattle Center Foundation. Thank you for volunteering. Each volunteer is required to read and sign this Volunteer Agreement and Liability Waiver as a condition of participating in the event.

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

For All Volunteers

1. I am donating my services (“SKC Clinic Services”) and I am not entitled to any present or future salary, wages, or other benefits for providing SKC Clinic Services.

2. I understand that the City of Seattle provides limited reimbursement for an injury to a volunteer while providing volunteer services for the City and that the coverage is secondary to any other insurance I may have.

3. I understand that the City of Seattle will appear and defend a claim or lawsuit against me if the claim or lawsuit arises from my volunteer activities, as authorized and limited by Seattle Municipal Code 4.64.100 and .110, except as limited below for professional services provided by clinical providers.

4. 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 SKC Clinic officials. I understand if I am exposed, SKC Clinic will provide any relevant onsite test(s) at no cost to me and I agree to be tested if I am the source of an exposure. It is further understood that I am responsible for the cost of all subsequent tests, treatments and medical care.

5. I knowingly assume the risk of participating as a volunteer for SKC Clinic. In consideration of participating as a volunteer for the SKC Clinic, I, for myself, my spouse, my legal representatives, heirs, and assigns, hereby forever unconditionally waive all claims (in law, equity, or otherwise) against SKC Clinic, The City of Seattle, Seattle Center Foundation, and their respective subsidiaries, affiliates, partners, officers, trustees, officials, employees, and agents, and volunteers, (collectively, "SKC Clinic Parties"), arising out of my participation in the SKC Clinic and my provision of SKC Clinic 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).

6. I also grant SKC Clinic, City of Seattle/Seattle Center, Seattle Center Foundation 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 SKC Clinic services and activities in all forms of media in perpetuity.

7. I agree to notify SKC Clinic 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 SKC Clinic 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 SKC Clinic Services. I will either agree to the background check or I may decline to volunteer.

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 SKC Clinic 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 SKC Clinic 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 off-site as well as at any clinic sites.

Confidential information may include, but is not limited to:

• Patient information (health records, conversations, demographic information, contact information).

• Volunteer information (contact information, license information).

• Proprietary information (financial reports, production reports, strategic plans, contracts, 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 notify my supervisor.

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 SKC Clinic has the right to conduct and maintain an audit trail of all access to patient and volunteer information and other system activity such as internet access and SKC Clinic 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 SKC Clinic 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 SKC Clinic.

Special Provisions Applicable to Clinical Providers

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

A. I represent that I have all 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 SKC Clinic officials if my license or disciplinary status changes.

C. I am responsible for performing the SKC Clinic 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 SKC Clinic Parties (as defined in 5 above). As a result, I agree that while I am donating my services to the SKC Clinic, I will not be considered a volunteer under the direction of the City of Seattle or the SKC Clinic 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 SKC Clinic Parties (as defined 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 SKC Clinic.

F. I agree to maintain a professional liability policy relative to my performance of SKC Clinic Services in effect throughout the SKC Clinic. I further agree to inform SKC Clinic of the insurance carrier and policy number with whom I have the professional liability policy. I grant SKC Clinic, City of Seattle, Seattle Center Foundation and their respective agents the right to submit any claims arising out of my performance of SKC Clinic Services to the appropriate professional liability carrier for further handling pursuant to the terms of my policy.

G. Any follow up treatment provided by me to a patient at a different location or after the SKC Clinic dates is outside the scope of SKC Clinic Services.

H. My acceptance of this agreement signifies that I give permission to SKC Clinic to verify the status of my license, my insurance, 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.