• Volunteer Registration Form

    All fields must be completed.

  • Emergency Contact Info


    Please note: Some sites are only offering the Diabetes Risk Assessments, while other locations are also offering A1c tests. For those sites doing A1c tests, the Diabetes Coalition requires medical professionals (physicians, nurses, pharmacists, etc.) provide only those services that are defined by Florida Statute as “within the scope” of their professional license).

    All volunteers completing diabetes risk assessment screenings must complete training, prior to assisting with the tests.

  • Geographic Areas

  • Please list all days and times that you are available to volunteer.

    I am available to volunteer on the following days(s), location(s) and times:

  • You will be contacted by Debby Walters via email/or phone, regarding your assigned screening site location(s), dates/days, and times you will be needed. If you have any questions, please contact Debby Walters at debby@diabetescoalitionpbc.org

    All volunteers are asked to report to the screening site location at least 30 minutes prior to the actual event, to allow for set-up and if relieving another volunteer, for a smooth transition.

    Again, we will confirm your participation via email and provide you with the screening site’s coordinator or contact person, and phone number.

    If for any reason, you unable to volunteer on the date or dates you signed up for, volunteers are asked to give at least a 72-hour notice.
  • This field is for validation purposes and should be left unchanged.