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. We will not sell or share your information with sources outside of the Clinic.

RETURNING PARTICIPANTS

1. 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. 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 do so promptly 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.
 
     
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 6 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.
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
    Computer Proficiency - Intermediate    
    Blood Borne Pathogen Training    
    Vaccinated for Hepatitis B    
    Clinic Volunteer in 2014    
    Clinic Volunteer in 2015    
    Member of Public Health or WA Medical Reserve Corps
    Please include your reserve corps ID number in comment box.
    Healthcare Office or Operations Experience
    Briefly describe in comment box, unless you are a licensed healthcare provider.
          
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  
Your Relationship to Contact    
Phone    
   
Event Area
  Select the area appropriate to your profession / classification.
Profession / Classification
General Notes
(if needed)
 
License Number   Enter "none" if a license is optional for your profession and you do not have a license.  Set the Expiration Date in the future.
Expiration Date    
Prof. Liability Insurance Carrier   Professional liability insurance is your responsibility. WA providers may be able to get free coverage from the Department of Health through the Volunteer and Retired Provider program.
State of Licensure   Only U.S. licensed professionals can volunteer as providers. Out-of-state providers MUST submit an attestation form to the Department of Health in order to volunteer.
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 type of involvement in direct patient care. The criteria for student participation also varies by discipline. Please follow the instructions below to determine if you are eligible to sign up in a student capacity.

  1. Look at the table to see if your field is listed. If it is, be sure to indicate that student designation as your Profession/Classification in the section above. If your field is not listed, we encourage you to select the Profession/Classification "General Support" so you can still experience the clinic and contribute to serving people in need.
  2. If your field is listed, next look to see what year(s) of study we accept in a student capacity and whether you will need to arrange to have a supervisor be with you onsite.
  3. If you are required to plan for an onsite supervisor, that person must be a licensed faculty member from your school and will need to register individually. If you do not arrange for a 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 supervisor may work with multiple students in one day.


Student FieldYear(s) of StudyOn-Site Supervisor Required
Dental Assisting StudentAllNo
Dental Hygiene StudentAllNo
Dental StudentAllNo
Dietician or Nutrition StudentDietetic Intern or Master's LevelYes, one will be assigned on clinic days
Medical StudentAllNo
Nursing StudentAllNo
Ophthalmology StudentFinal YearYes, try to plan your own for clinic days, otherwise we will assign
Opticianry Student2nd YearYes, one will be assigned on clinic days
Optometry StudentFinal YearYes, try to plan your own for clinic days, otherwise we will assign
Paramedic StudentAllNo
Pharmacy StudentInternNo
Physical Therapy StudentAllNo
Psychology/Mental Health StudentGraduate LevelYes, must plan your own for clinic days
Public Health StudentAllNo
Social Work StudentMaster's Level 2nd YearYes, one will be assigned on clinic days
School    
Field of Study / Degree Program    
Year of Study    
Onsite Faculty Supervisor    
       
 
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 or "Not Attending This Day." 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 (i.e. Dental Hygiene) you will be given the option to select an alternate assignment (i.e. General Support). If an opening becomes available in your preferred assignment and you are moved from the waiting list, you will receive an email notice of this change. If you also selected an alternate assignment, you will be automatically canceled from the alternate assignment.

Healthcare professionals and students willing to help on set up and take down days may not see their professional assignment (i.e. Nursing, Social Work) listed on those days as no patients will be present. Instead, they should select a General Support or other listed assignment that is involved with set up and take down.

For descriptions of select assignments go to seattlecenter.org/assignments.

    
Admin Code
For administrative or instructed use only.
Day Type Assignment
   
     
   
The Seattle\King County Clinic (“SKC Clinic”) is a joint event of the Seattle Center 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 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:

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 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 initial blood 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.

6. 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.

7. 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.

8. 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.

9. I understand that SKC Clinic officials maintain the right to revoke my participation at any time with or without cause.

10. Some volunteer positions may require a Washington State Patrol background check to volunteer for SKC Clinic Services. If required, I will either agree to the background check or I may decline to volunteer.

Special Provisions Applicable to Clinical Providers:

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

• 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.

• I shall inform SKC Clinic officials if my license or disciplinary status changes.

• 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.

• 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.

• 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 in 5 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.

• 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 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.

• 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.

• 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.
   


        
       
   
       
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