ADULT Volunteer Registration: Saturday, October 29, 2022 Medication & Sharps Collection. Proudly supporting the Drug Enforcement Administration's National Drug Take Back Day
If you would like to register a Youth/Student, please complete the survey at
www.surveymonkey.com/r/Youth10-29-22
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OK
Adults only:
Thank you for wanting to volunteering for HC DrugFree's medication and sharps collection scheduled for Saturday, October 29 from 10 a.m. to 2 p.m. (with set up 9:15 a.m. and cleanup from 2:00 to 2:15 p.m.). Rain or shine, this is an outdoor event in the Wilde Lake Village Center parking lot. We will follow CDC and County safety guidance, but please have a mask with you and watch for COVID-related emails from HC DrugFree. (Teens/students, please use "Youth Registration" linked above and not this one! Contact Admin@hcdrugfree.org with questions. Thank you.)
Please register at the event's Volunteer Table.
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1.
Adult's first name
(Required.)
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2.
Last name
(Required.)
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3.
Will you be joining/chaperoning your student or member of our Teen Advisory Council?
(Required.)
Yes
No
If Yes, name of the registered student(s) joining you:
*
4.
Would you like to bring any other student(s) with you?
(Required.)
Yes
No
If Yes, name and age of the student(s) joining you:
*
5.
Email address
(Required.)
*
6.
Re-enter email address
(Required.)
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7.
Phone number
(Required.)
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8.
Re-enter phone number
(Required.)
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9.
EXACT time between 9:15 a.m. and 2:15 p.m. that you will volunteer
(Required.)
All day - 9:15 to 2:15 (We encourage volunteers to bring lunch or snacks. Restaurants in plaza. HCDF hopes to provide some snacks/water.
Morning only - 9:15 to noon
Afternoon only - noon to 2:00
Other (please specify exact time)
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10.
Are you willing to volunteer rain or shine?
(Required.)
Yes
No
Other (please specify)
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11.
Are you willing to hold a sign or direct traffic from a safe sidewalk location?
(Required.)
Yes
No
Other (please specify)
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12.
Are you able to stand, or if you prefer to sit, will you provide your own lawn chair? (We will not provide chairs.)
(Required.)
Yes
No
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13.
Most volunteers will not handle medication and sharps, but we are looking for trained volunteers to assist. Do you have medical training to handle medication and sharps?
(Required.)
Yes
No (now skip to question #15)
14.
If answered YES above and you have medical training, please specify:
Doctor/Nurse
Pharmacist
EMT
Other (please specify)
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15.
Volunteers must follow HC DrugFree's guidance and procedures based on CDC or County guidelines in effect on October 29. To keep everyone safe, you may be required to wear a mask and/or socially distance. Do you agree?
(Required.)
Yes
No (please specify)
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16.
Volunteers wear HC DrugFree t-shirts. Do you already have our t-shirt?
(Required.)
Yes
If no, what size in case we can provide them?
By submitting this registration, I agree to this waiver(s):
I have read this waiver and knowing the facts, I, for myself and anyone entitled to act on my behalf, waive and release HC DrugFree and its employees, directors, officers, partners, agents, and sponsors from and against all claims, demands or causes of actions for accidents, personal injury, bodily injury, death, property damage or other injury or loss or damage of any kind, occurring from any cause arising from or related to or in connection with named participant’s involvement in the event named above.
Further, I grant permission to all of the foregoing to use named participant’s photographs, audio and audio visual recordings or any other record of this event for any legitimate purpose.
Additional waiver for volunteers handling sharps & medication:
In addition to above, I understand proper handling of meds and sharps, agree to wear provided gloves and protective items, and assume the risk of picking up medications and sharps and placing them in the proper bins. I will decide the appropriate medical care for such, and I understand that it is my responsibility to IMMEDIATELY report any injury (splash, needle stick, cut, etc.) to HC DrugFree’s Executive Director or Board Member present at this event.
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