Request for Medical Reserve Corps Volunteers Form - Southern Nevada Health District

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Volunteer Opportunities

Community Health Volunteers

Medical Reserve Corps

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Volunteer Opportunities

Medical Reserve Corps of Southern Nevada
Volunteer Request Form

Medical Reserve Corps (MRC) of Southern Nevada volunteers may be available to promote public health campaigns, staff first aid stations at community events, provide health screenings at health fairs, and more.

Upon submitting the form, a volunteer coordinator will determine the availability of volunteers and respond to your request within one business day. Note: Submitting a request does not guarantee volunteers will be available to participate in your event.

Requestor's Name*

Title

Agency

Phone

Fax

Email Address*

Type of event:

Number of attendees expected:

Volunteer Job Duties:*
Please select at least one Volunteer Job Duty

Blood Pressure Screening Clinic Support Disaster Responder Support First Aid Support	Preparedness Material Distribution Public Health Education Surveillance and Notification Vaccine Administration
Other:

Event Date*	Start Time*	End Time*	Volunteers Needed*

Add another date for this event.

Would shifts be required or available?

Type of Licensure Required: Medical Non-Medical Veterinary
Please select the licensure required

Would a signed release of liability be required? Yes No
Please select an option for the Liability Release

Event Location:

Street Address:

City:

State:

ZIP Code:

To whom would the volunteer report?

Contact Name

Contact Phone Number

Would onsite parking be available? Yes No
Please select an option for will parking be available.
Provide directions, if necessary:

Would water be available? Yes No
Please select an option for will water be available.

Would meals/snacks be provided? Yes No
Please select an option for will meals/snacks be available.
If yes, please describe.

Additional instructions (dress code, PPE requirements, etc.)

Type the words from the verification image for verification purposes, then click "submit."