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April 24, 2017

Monday, April 24, 2017
4:00 pm7:00 pm

Monday, April 24, 2017
4:00 pm7:00 pm

Volunteer

DO YOU HAVE A HEART TO SERVE OTHERS? If so, please consider volunteering with Clinic with a Heart. We are in need of medical and non-medical volunteers.

Current Openings

  • Medical Providers (Physicians, Advanced Practice Registered Nurses, Physician Assistants)
  • Mental Health Professionals
  • Optometrists and Opthalmologists
  • Dental Assistants -- xray certified
  • Dental Hygienists
  • Vision Technicians
  • Nurses
  • Fundraising/PR Volunteers
  • Spanish Interpreters

For more information contact:

Spencer Randazzo, Director of Volunteers
spencer@clinicwithaheart.org
402-499-6470 (phone)
888-317-8608 (fax)

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Salutation
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If you hold a Nebraska medical license, please select the type of license
Have you previously held a Nebraska medical license in any of the following?
Select local hospitals where you are credentialed
Are you a student?
What languages do you speak (check all that apply)?
Work Experience
Volunteer Experience
Select evening clinics for which you are available
Are you available to volunteer during daytime hours?
How did you hear about Clinic with a Heart?
Are you affiliated with any of the Clinic with a Heart mission team sponsors listed?
If yes, please select
Have you ever been convicted of a misdemeanor?
Have you ever been convicted of a felony?
Emergency Contact

VOLUNTEER STATEMENT: I am at least 19 years of age and I wish to donate my services to Clinic with a Heart. I understand there is no payment for services rendered. I understand I may be asked to participate in photos of CWAH activities without expectation of any type of remuneration. I understand I may be subject to corrective action or dismissal from the CWAH volunteer program for failure to abide by the policies and procedures of CWAH. To the best of my knowledge I am in good health and able to perform assigned duties.

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VOLUNTEER ACKNOWLEDGEMENT AND RELEASE AGREEMENT

In consideration of the participation of the undersigned (the “Team Member”), an individual who is at least 19 years of age, in or with Clinic with a Heart, Inc., a Nebraska nonprofit corporation (the "Clinic”), the receipt and sufficiency of which is expressly acknowledged, Team Member understands, warrants and agrees as follows (the “Agreement”):

1. Release of Liability.

Team Member acknowledges and agrees that:

  • Health care, in any form and especially involving donated services in free clinic settings can be an inherently dangerous activity, carrying the significant risk of serious personal injury or death;
  • The conditions and risks are frequently beyond the control of the Clinic and the Clinic is not able to completely mitigate such risks to the Team Member; and
  • Team Member shall, at all times be responsible for, and shall be required to exercise all reasonable care for his/her own safety.

Except to the extent covered by the Clinic’s Blanket Accident Insurance policy, Team Member, for him/her self, spouse, successor, and heirs, does hereby release, waive, absolve, discharge and agree to hold harmless the Clinic, including other Team Members and the Clinic’s representatives, officers, directors, employees, agents, affiliates, insurers and attorneys (collectively, the "Released Parties"), from and against any and all rights, claims, demands, causes of action, obligations, suits, liens, damages or liabilities of any kind and character whatsoever, whether known or unknown, suspected or claimed, which Team Member shall or may have in the future against the Released Parties arising out of, based on, related to or connected with Team Member's participation in any Clinic related activities.

2. Personal Responsibility.

Team Member agrees that upon becoming a volunteer with the Clinic, he/she WILL:

  • Adhere to the Policy and Procedures of Clinic with a Heart. Stay informed about Clinic operations, events, and changes by accepting and reading the monthly electronic newsletter and communication memos from the Clinic;
  • Participate in relevant educational offerings;
  • Record volunteer work time in and out and position worked;
  • Know his/her team/discipline assignment and his/her team/discipline leader and how to contact him/her;
  • Utilize his/her team/discipline sign up scheduling system in advance of the clinic/meeting, and if unable to fill a work commitment, notify the team/discipline leader in advance;
  • Learn and perform the duties of his/her position and seek assistance if needed;
  • Treat patients, guests, and other volunteers with dignity and respect;
  • Share concerns or ideas for improvement with a team leader or Clinic staff;
  • Participate in the welcoming and orientation of new Clinic volunteers. 

3. Additional Terms.

Team Member acknowledges that the Agreement is executed in exchange for the opportunity to participate in the Clinic and the Clinic related activities. This Agreement shall remain in force until written revocation thereof is delivered to the Clinic, however, Team Member recognizes that such revocation will result in Team Member being prohibited from further participation in the Clinic and the Clinic related activities. The Clinic reserves the right to terminate Team Member’s participation in the Clinic and Clinic related activities at any time in its sole discretion with or without notice.

Team Member has read the Agreement in its entirety, understands it, voluntarily agrees to it, and further understands that Team Member has given up substantial rights by signing it. The person(s) signing this document has full authority and capacity to do so. If any portion of this Agreement is found to be invalid, the remainder shall continue in full force and effect. This Agreement shall be binding upon the Team Member and his/her respective heirs, personal and legal representatives, and successors.

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