Volunteer Form: Adath Pop-Up Vaccine Clinic

If you are age 16+ and wish to volunteer at our August 15th pop-up clinic, please fill out the Volunteer registration form below.

If more than one member of your family would like to volunteer, please fill out a separate form.

We recommend that all volunteers should have received their second vaccination at least 14 days prior.

* First Name

* Last Name

* Mobile Phone

* Email Address

* Address

* City

* Postal Code

Are you 16 years of age or over?

Please choose your preferred volunteer shift below.

Please Choose One9:30 am - 12:45 pm - Fully Booked12:45 pm - 4:00 pm - 3 of 10 LeftIf your preferred arrival time is taken,
please choose another available time slot.

If you begin to show symptoms of COVID-19, you should:

Not attend the vaccination clinic on August 15th and let Adath Israel know (Email: phil@adathisrael.com)
Go to a COVID-19 assessment Center to get tested;
Stay home and self-isolate unless you are going to the assessment center.
Tell people you were in close physical contact with in the 48 hours before your symptoms began to monitor their health and to self-isolate

Thank you very much. We will be in touch with more details to confirm your submission. Please check your email regularly.

Wed, 24 April 2024 16 Nisan 5784