Volunteer Sign up Form
We’re thrilled to have your support at the CKD screening event tentatively on Monday, June 29 at the Flowood Family YMCA (690 Liberty Road, Flowood MS 39232) and Tuesday, June 30 at the Clinton Branch YMCA (400 Lindale St, Clinton MS, 39056). Thanks to your help, we’ll provide rapid CKD assessments to participants, identifying signs of kidney issues and related risk factors. In addition to on-site health testing, participants will receive personalized education, prevention materials, and resources to support their health journey. Please note that volunteers must be 18 years of age or older. Thank you for being part of our volunteer team!
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Please indicate your affiliated organization:
*
YMCA
Other
Job Title
*
List any medical certifications you hold.
This event needs volunteer support on June 22 and 23rd. The specific screening times will be finalized and shared soon. Please pay attention to the location of the screening and indicate the day(s) you're able to volunteer.
*
Mon, June 29: 8 am - 3 pm (full shift at the Flowood Branch YMCA)
Tue, June 30: 10 am - 5 pm (full shift at the Clinton Branch YMCA)
Other
Are you able to provide bi- or multi-lingual translation support on site?
*
Yes
No
If yes, what language(s)?
What is your T-shirt size? Please note due to limited inventory, we may not be able to accommodate all sizes.
*
XS (Extra Small)
S (Small)
M (Medium)
L (Large)
XL (Extra Large)
XXL (2XL)
XXXL (3XL)
Any special message you need us to know?
*Please Note: There will be a virtual orientation prior to the screening.
Invites will be sent as we get closer to the dates!
Submit Form
Should be Empty: