Skippack Pharmacy Volunteer Interest Form

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Please fill out the form below if you would like to continue to volunteer for Skippack Pharmacy. This includes any position. You will NOT receive clinic or weekday volunteers emails unless you fill out this form.

Please select all that are applicable.

First Name *

Last Name *

Phone Number *

Email *

I would like to be a weekday volunteer at the pharmacy (Skippack Pharmacy)

Vaccinator (Licensed in PA)

I would like to be a weekday volunteer at the pharmacy (Skippack Pharmacy)

Computer Support (Check in/out)

I would like to be an off-site clinic volunteer

Vaccinator (Licensed in PA)

I would like to be an off-site clinic volunteer

Vaccine Drawer (Licensed in PA, trained by Skippack Pharmacy)

I would like to be an off-site clinic volunteer.

Computer Support (Check in/out)

I would like to be an off-site clinic volunteer.

Event support (flow, temperature check, observation, screening)

I would like to be an off-site clinic volunteer.

Dedicated Medical (CPR Certified)

I would like to help with homebound patients.

Vaccinator (Licensed in PA)

What is your volunteer experience?

I have volunteered before for Skippack Pharmacy's COVID Task Force

I have not volunteered yet on your team but am signing up as a first time volunteer for the COVID Task Force

Is there anything else you'd like to let our team know?

All volunteers must sign the updated HIPPA Form to volunteer. Link: https://hipaa.jotform.com/210443923290046 *

I have signed the updated HIPPA Form

Medical volunteers must send in licensures (Acknowledge by checking below and clicking link to submit information)

Please go to the following site to submit your licensure to vaccinate and/or be a part of the medical team. Link: https://hipaa.jotform.com/SkippackPharmacy/MedicalVolunteerLicenses

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