Screening 4 Your Health Survey
RequiredRequired Question(s)
VOLUNTEER SIGN UP FORM

Volunteers should report to the Youth Heart Screening Event school gym at their scheduled time. For questions or concerns, please contact Monique Bradley at dariusjonesfoundation@gmail.com or call 925-360-4624.

Be sure to complete all sections where you desire to volunteer. Multiple shifts are available.
 
1.

Are you medical personnel? If so, select type: 

Physician
Sonographer
Other  
2.

*MEDICAL PERSONNEL ONLY*

If you are medical personnel please choose a time slot.  

8:00 a.m. to 4:00 p.m.
8:00 a.m. to 12:00 p.m.
12:00 p.m. to 4:00 p.m.
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Required 3.
Are you interested in volunteering? If so, please fill out the following information.

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com

Required 4.

Which school(s) are you willing to participate as a volunteer?  

(This list will be updated as confirmations are made with local schools.) 

Haskell H.S. - Haskell, TX (June 19, 2017)
TBD
Other  
5.
INTAKE STATION: helps with the check in process. Duties will include welcoming all registrants; also review and complete paperwork before the screening begins. Non-medical and medical volunteers are welcome. Please select time intervals preferred.
7:30 a.m. to 12:00 noon (Includes set-up)
12:00 noon to 4:00 p.m.
9:00 a.m. to 5:00 p.m. (includes break down)
6.
WEIGHT & HEIGHT STATION: record weight and height of registrants. Non-medical and medical volunteers are welcome. Please select time intervals preferred.
7:30 to 12:00 noon (includes set-up)
12:00 noon to 4:00 p.m.
9:00 a.m. to 5:00 p.m. (includes break down)
7.
BLOOD PRESSURE CHECK STATION: record registrants blood pressure. Medical volunteers preferred. Please select time intervals preferred.
7:30 a.m. to 12:00 noon (includes set up)
12:00 noon to 4:00 p.m.
9:00 a.m. to 5:00 p.m. (includes break down)
8.
DIRECTORS: help with the screening process to insure every registrant is seen. Miscellaneous duties may include assisting with gown changes and other assignments. Medical and non-medical volunteers are welcome. Please select time intervals preferred.
7:30 a.m. to 12:00 noon (includes set up)
12:00 noon. to 4:00 p.m.
9:00 a.m. to 5:00 p.m. (includes break down)
9.
HANDS-ONLY CPR/AED TRAINING STATION: give instruction to registrants on how to perform CPR and use the AED device. Medical volunteers preferred. Please select time intervals preferred.
7:30 to 12:00 noon (includes set up)
12:00 noon to 4:00 p.m.
9:00 a.m. to 5:00 p.m. (includes break down)
10.
CHECK OUT STATION: perform wrap up session with registrants. Distribute giveaway bags, encourage healthy lifestyle choices and follow up options with registrants. Medical and non-medical volunteers are welcome. Please select time intervals preferred.
7:30 to 12:00 noon (includes set up)
12:00 noon to 4:00 p.m.
9:00 to 5:00 p.m. (includes break down)