• Volunteer Registration Form


    All fields with an asterisk (*) must be completed.

  • Emergency Contact Info

  • Volunteer Opportunities Available

    Screening Site Packets and “Goodie Bag” Preparations October 24-27, 2017

  • I would like to volunteer and am available on the following dates and times:

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  • Location Address: Keizer University – Dates, Times, and Locations to be determined.

    Diabetes Awareness Day at the Palm Beach Outlets Saturday, November 11th – from 11:00 pm to 3:00 pm.

    Volunteers are needed for Pre-Event Set-up and Post-Event Clean-up Activities at the Outlets, which is located at 1751 Palm Beach Lakes Blvd, West Palm Beach, FL 33401

  • I would like to help and will at the Palm Beach Outlets at:
  • I would like to help (could be earlier if event ends early):

  • VOLUNTEER SIGN-UP SHEET FOR DIABETES MONTH 2017 SCREENING SITES

    Please note: Some sites are only offering the Diabetes Risk Assessments, while other locations are also offering Glucose Screenings. For those sites doing glucose screenings, 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.

  • 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

    Please note: We recognize that you may not be able to volunteer for the entire time of the screening event, but we ask that you commit to as much time as possible.



    All volunteers are asked to report to the site location 30 minutes prior to the actual screening 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, please notify Debby Walters immediately at debby@diabetescoalitionpbc.org. Volunteers are asked to give at least 72 hours notice.

  • Volunteer Training

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

  • This field is for validation purposes and should be left unchanged.