ACT Kids Healthfair

Food & Refreshments Volunteer Registration Form

First Name:	* Required
Last Name:	* Required
Employer/School/Clinic:
Mailing Address:	* Required
City:	* Required
State:	* Required
Zip:	* Required
Contact Phone Number:	* Required
Email:	* Required
Do you speak conversational Spanish? Yes No
Are you available to stay 7:00am to 4:00pm? Yes No
Are you available to stay after the fair to help clean up? Yes No

HAVE YOU PREVIOUSLY VOLUNTEERED TO DO:
Asthma	Yes No
Blood/Lead	Yes No
Dental	Yes No
Literacy	Yes No
Display Table/Booth	Yes No
Escort	Yes No
Hearing	Yes No
Immunizations	Yes No
Logistics/Security	Yes No
Parking	Yes No
Physicals	Yes No
Refreshments	Yes No
Registration/Tally	Yes No
Event Coordination Team	Yes No
Vision	Yes No

HAVE YOU BEEN RECRUITED THIS YEAR FOR A SPECIFIC AREA?:
	NONE
	Asthma
	Blood/Lead
	Dental
	Literacy
	Display Table/Booth
	Escort
	Hearing
	Immunizations
	Logistics/Security
	Parking
	Physicals
	Refreshments
	Registration/Tally
	Event Coordination Team
	Vision

ARE YOU A:
Medical Interpreter	Yes No
Entertainer	Yes No

Do you work for HEAD START? Yes (Name:) No
What is your T-Shirt size?
	NOTE: When volunteering a valid photo id will be required.