Community Volunteer

With your help we expect to treat hundreds of patients in two days thank you for volunteering! Volunteer jobs may require standing or walking for long periods of time, and some jobs may involve lifting/carrying heavy objects or working outside.

Note: Community volunteers must be age eighteen or older. Volunteers under age eighteen can volunteer for Thursday set up and/or Saturday tear down only.

Required field(s) are indicated by an *.
I pledge to be present for (select all that apply):
Please select your first choice
Please select your second choice
Please select your third choice
"Clinic ending times and breakdown on Saturday vary depending on the size of the clinic."
I understand there is potential risk for exposure to bloodborne pathogens (BBP's) including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV), as well as other bacteria, protozoa, viruses and prions during the performance of my volunteer service at this NCMOM project. I understand that I am personally responsible for any medical fees and services associated with a percutaneous piercing wound typically set by a needle point, but possibly by other sharp instruments or objects.

I understand that this is a donation of my services and that I am responsible for my own travel, accommodations, meals and medical care. I also understand that I am not entitled to reimbursement from the Dental Society or the NC Dental Health Fund for any of my expenditures.

* Date / / (MM/DD/YYYY)