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Patients and Guests

Vaccination Volunteers Needed

Credentials are Required

Thank you for your willingness to help administer the COVID-19 vaccination at UAMS.

Before filling out the form below, you will need to review the following files.

COVID-19 Waiver FormDownload
Fire and Safety RACE – PASSDownload
Photography Release AgreementDownload
Service Description COVID-19 Vaccine Clinic 2021Download
UAMS Confidentiality Policy 2.1.01Download
UAMS HIPAA Level I Training FormDownload
UAMS Incident Injury Reporting Policy 11.4.01Download
What is Culture SmartDownload
Volunteer ContractDownload
Volunteer Handbook (Revised 01.31.2018)Download

Once the files have been reviewed, electronically sign and submit your Confidentiality Agreement and then fill out the form below.

Covid-19 Vaccine Volunteers

  • Name * Required
  • Address * Required
  • Digital Signature * Required
    By checking this box, I acknowledge that I have read each document in its entirety and that I am choosing to sign this form digitally.