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NC MOM Community Volunteer Registration Form

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. Descriptions for each volunteer position are shown below.
Clinic Selection: (Please make your selection. Registration for additional clinic dates will open approximately one month prior to the scheduled event. Additional dates require an additional form submission.) ** IF YOU ARE A SPANISH INTERPRETER THAT CAN HELP AT THE CLINIC IN SALISBURY, PLEASE CONTACT KRISTA WOOLY AT (704) 636-4523 ex204**


Please check for accuracy as this will be the email used for confirmation.

Below this form is a list of Community Volunteer Job Descriptions. In an effort to assign Volunteers in an efficient manner, please select job preferences from the list below.

I prefer to do:














I pledge to be present for: (Multiple selections are welcome)

  • Please select each time slot you are volunteering for.  
  • Upon submitting, your registration for those date(s) & time(s) is automatically confirmed.
  • Select "N/A" for times that you are unable to attend. 
Thursday (Setup):


Friday Morning:


Friday Afternoon:


Saturday Morning:


Saturday Afternoon:


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.

Job Descriptions

  1. Unload trucks and Set-Up Clinic: Help unload NC MOM supply trucks at site and set up clinic areas with portable dental equipment as directed by MOM personnel. Set up tables and chairs, lay out electric cords and air compressor hoses, put up signs etc. and anything else that needs to be done. Must be able to carry heavy boxes and help move equipment around the site.

  2. Volunteer Registration: Maintain volunteer sign-in sheets for all volunteers. Separate sign-in sheets are maintained for each job type. Distribute name-tags, wristbands or t-shirts for volunteers. Tally and report volunteer numbers to Data Entry at end of each day. Have at least one Volunteer Registration person available for Thursday set-up onsite by 9:45 a.m. to welcome set-up volunteers.

  3. Patient Registration: Greet the patients, hand out registration forms, facilitate patient flow up to and from the registration tables, and direct registered patients on to the Health Screening/Triage area. Assist patients in filling out the Registration Forms completely. Knowledge of Spanish can be helpful.

  4. Spanish-English Translators: Serve as translators to assist communication between patients and clinic personnel. Must be able to stand and walk for extended periods of time.

  5. Health History and Blood Pressure Screening: Should be recruited by Dental Team’s Medical Leader. Nurses work best in these roles and are encouraged to bring BP cuffs. Volunteers must be medically qualified to take patient’s health history and blood pressure reading; assists and monitors patients in the patient recovery area as needed.

  6. Triage Volunteers: Records examination comments and instructions as directed by the Triage Dentist; assists and performs small errands as directed by the Triage Dentist. One Scribe required per Triage Dentist. Dentists who register for this position often bring their own assistant to scribe, and Pre-Dental Student Volunteers can fill in these roles if needed.

  7. Patient Flow: Escort patients from facility Entrance or inside/outside Waiting areas to Registration area; from Registration to Health Screening area; from Health Screening to X-Ray area; from X-Ray to Triage area; from Triage to designated Treatment Waiting areas; from Treatment Waiting areas to specific dentist or hygienist in the Treatment area; from Treatment to Recovery area, if needed; from Recovery to Check Out area; from Check Out to facility Exit. Must be able to stand and walk for extended periods of time.

  8. Treatment Waiting Area Receptionist: Maintains line and patient order in separate treatment lines. Will need to be organized, responsible and firm volunteers. Will communicate with patient flow volunteers to keep line of patients moving safely and efficiently onto clinic floor. Will keep track of line pacing in order to give timing updates to NCMOM Director.

  9. Runner/Errands: Runners take supplies to treatment stations and help dentists/clinic personnel with small errands as requested. Will also use signs to direct new patients onto clinic floor and retrieve patients for dentists. Should not have a queasy stomach, as these volunteers will witness dentistry in action!

  10. Trash Disposal: Dispose of solid waste throughout event. Will need to wear disposable Personal Protective Equipment (provided at the clinic). Pre-Dental Student Volunteers and NCMOM Staff will assist in trash disposal. Should have Hepatitis B vaccine. Confirm disposal location and routines with Facilities Team.

  11. Patient Checkout: Collect registration forms from patients who have completed their treatment; provide gauze packs and instructions to those who have had extractions; make sure that treatment received and the treatment provider are accurately documented on patient’s registration form; assist patients who wish to make a written comment about the clinic; assist patients in locating their family/friends in the waiting area, if needed; return completed registration forms to data entry area.

  12. Data Entry: Computerize the statistics from the entire clinic with regard to patient numbers, procedures performed and volunteer participation. May need to stay later in the day in order to capture numbers after final patients are seen.

  13. Tear-Down Clinic and Load Supply Trucks: Help pack equipment and supplies after proper disinfection and load supply trucks as directed by NC MOM personnel. Must be able to carry heavy boxes and help move equipment around the site. Official ending time of the clinic is never possible to determine in advance, but NCMOM Staff’s goal is to be finished and on the road before 8 p.m. Saturday of a clinic. Check with NCMOM Operations Manager to see how many Pre-Dental Student Volunteers will be in place to assist in loading Saturday afternoon.

  14. Parking Lot and Traffic Control: Volunteers assist in maintaining orderly flow of vehicles in parking lots and directing patients to the entrance. Must be able to stand for extended periods and work outside in variable weather conditions. Work with Facilities Team and Parking Leader to determine best way to recruit and coordinate these volunteers.
"State":"NC"