Thank you for your interest in volunteering with Mission of Mercy Pittsburgh.

From here you can sign up as a volunteer, register for events, and change your assignments. For Clinical Volunteer questions email clinicalconcierge@mompgh.org. For General Volunteer enquiries email info@mompgh.org.

 
      If you previously registered on this webpage, we will recall your information.
Do not RECALL your information and type over it for another family member. That overlays the existing record.
 
 
Abbreviated Title   Example: Mr., Ms., Dr., Hon., Mx.
 
     
Professional Abbreviations       Example: DDS, MD, PhD
Name on Badge       List the information you want to appear on your badge.
Example: Dr. Jeff, Ms.King, Sam
 
 
  If possible, we would like to text you with occasional reminders and pertinent updates.
Mailing Address Line 1   Include apartment, suite or box number, if applicable.
Mailing Address Line 2  
 
 
 
  We recommend an email address unique to the registered volunteer instead of a shared office address or the personal address of a group leader for all group members. We will send personalized scheduling correspondence to this address.
 
        
  Establish your unique User Name. You may use your email address as your User Name unless another registered volunteer will be receiving correspondence at that same address. 
        
  Used to recall your information when you visit this site again so you can make changes and/or select additional volunteer opportunities.  Your password must be at least 8 characters and contain at least one letter and one number. It may not contain the characters  < ' & * # .
 
       
Required Age
  I will be at least 16 years of age when I volunteer.
  For legal reasons these are the age restrictions for volunteering.
 
T-Shirt Size   T-Shirt style is adult unisex.  Note that t-shirts may not be provided at all events.
Language Fluency (other than English)
Select all that apply 		  Hold down the control key to select more than one language.
Hold down the control key and click on a selected language to de-select it.
         
Other Information
    Blood Borne Pathogen Certified     Have you taken an infection control/ blood-borne pathogen certification training?
    Vaccinated for Hepatitis B    
    Are you registering as part of a group?     If you are, please click yes and then select the group from the list that appears.
 
   Specify the group you are affiliated with
    
   
    Are you affiliated with any of our sponsors?     If you are, please click yes and then select the sponsor from the list that appears.
 
   Specify the sponsor you are affiliated with
    
   
          
Company / Organization   Optional, but helpful to know especially if you're coming with an office or team.
Matching
My company has a matching program
  Please indicate if your employer matches your donated time with a financial donation to the non-profit where you volunteer.
Description   Describe the program requirements and let us know how we can help - provide information for anyone we must contact and/or list any documentation you might need etc.
 
First and Last Name  
Relationship    
Phone    
   
Event Area
  Select the event area appropriate to your profession / classification.
Profession / Classification
General Notes
(if needed)
 
License Number   Enter "none" if a license is optional for your profession and you do not have a license. Set the Expiration Date in the future.
Expiration Date    
Prof. Liability Insurance Carrier   If you have any questions please contact clinicalconcierge@mompgh.org.
State of Licensure   Out-of-state providers MUST follow the procedures for out of state volunteers.

Only U.S. licensed professionals are able to volunteer as healthcare providers.
License Comment   List additional information we should know. Examples: You selected Other Professional - indicate field/specialty. Your license will renew before the clinic. You are licensed in a second field - provide license details.
     
Residency Location  
Residency Supervisor  
     

We welcome student participation at our clinics! We have three main types of student participation:

  1. Pre-Health: If you are in a pre-healthcare track (pre-med, pre-nursing, pre-dentistry, etc.), please select "General Support" as your assignment. Since you are not a licensed medical professional, we could use your help as a General Support volunteer where your tasks may range from helping in patient registration to dental sterilization, depending on your interests and our needs at the clinic. We are excited for your to get some volunteer experience with us!

  2. In Professional School - No Supervisor Present: If you are in medical, nursing, dental, etc. school yet you do not have a licensed faculty supervisor accompanying you to the clinic, you will not be able to practice patient care at the Your-Name-Here clinic. This means you will not be able to provide any medical services or treatments to our patients. You are welcome to sign up for your respective field's "Support" category. (i.e. Dental Support, Vision Support, Medical Support). This will allow you to assist the professionals in that clinic area by helping with patient flow, serving as a scribe to the licensed professional, etc. This is a great opportunity for your to gain shadowing experience or talk to professionals in the field you are studying while also helping the Mission of Mercy Pittsburgh clinic to run smoothly. Please fill out your school's information below.

  3. In Professional School - Supervisor Present: If you are in medical, nursing, dental, etc. school and you do have a licensed faculty supervisor that will accompany you to the clinic and if you are at least over halfway finished with your program and well into clinical rotations, then you MAY be able to practice patient care under your faculty's supervision. However, that supervisor must contact us at: clinicalconcierge@mompgh.org This is how our Volunteer Coordinators will provide the correct information, discuss the requirements, and approve your school for a specific clinic. Please fill out your school's information below.
School    
Field of Study / Degree Program    
Year of Study    
Onsite Faculty Supervisor    
       
 
Limit Event List by State?   Select a state to limit the list to only events in that state.
Event
  Signing up for more than one clinic?

Great! Finish your registration and pick your assignments for your first clinic, then click

SAVE AND SUBMIT at the bottom.

THEN, click the RECALL button at the top to pull up your record, scroll down, and pick your assignments for the second event (and repeat).
 
Event Location
---
  More detailed directions will be available prior to your arrival.
Event Email
---
  Please add this information to your safe senders/callers list.
Event Phone
---
 
Event Information
 
 
Please select an assignment for each day you plan to attend. If you are a clinical volunteer and you have any questions - please email clinicalconcierge@mompgh.org. For general volunteer enquiries, email info@mompgh.org. We appreciate your participation in making this event possible!

- Waiting Lists: if your preferred assignment is full, a waiting list option may be shown. If you choose to be on the waiting list for your preferred assignment, you will also be given the option to select an alternate assignment. If an opening becomes available in your preferred assignment, you will receive an email notice (and, if selected, a text message) automatically moving you to your preferred assignment. This will automatically cancel you from the alternate assignment.

    
Admin Code
For administrative or instructed use only.
Day Type Assignment
   
     
   
Select your profile picture   You may optionally upload a profile image. Just skip this option if you do not care to share an image. We accept GIF, JPG, and PNG images.
Your current picture
   
If you have been directed to upload a document of some kind please do so below. This is otherwise not necessary.
Document 1 Name      
Document 2 Name      
Document 3 Name      

No files have been uploaded
   
By signing below the undersigned Volunteer acknowledges his or her appreciation of the risks of participating in the Mission of Mercy – Pittsburgh Dental, Vision and Hearing Event (“MOMPGH”) hosted by a Call to Care, Inc. and its coordinating sponsor, including TeleTracking Technologies, Inc. (hereinafter “ACTC” and “TeleTracking,” respectively). The Volunteer, on behalf of themselves and their heirs hereby knowingly and voluntarily waives any right of recovery and releases ACTC and TeleTracking, their owners, directors, officers, officials, employees, volunteers and agents, from any and all liability, causes of action, and/or damages, no matter how characterized, including for personal injury (including death) and/or property damage arising out of undersigned’s involvement with or participation in MOMPGH.

The undersigned Volunteer further agrees to indemnify and hold ACTC and or TeleTracking harmless from and against any and all claims, damages, actions, liability and expenses, including attorney’s fees and other professional fees in connection with any bodily injury (including death) resulting from becoming exposed to and or contracting or spreading COVID-19 and/or damage to property arising from or out of the Volunteer’s activities and participation in volunteer services at MOMPGH.

The Volunteer further acknowledges and agrees that ACTC and TeleTracking do not assume any responsibility whatsoever for any personal property belonging to or the responsibility of the Volunteer and the Volunteer shall not hold ACTC and or TeleTracking liable for any loss or damage to the same.

The Volunteer also grants to ACTC and TeleTracking and their agents the right to use their picture, voice, and other reproductions of his or her physical likeness in connection with advertising or promoting ACTC and or TeleTracking philanthropic services and activities in all forms of media in perpetuity.

Sign in the space below:
Please use your mouse to sign on a PC or use your mobile device touch screen
 
Thank you for registering as a volunteer. Upon clicking the SAVE AND SUBMIT button, you will be emailed a confirmation of your registration/updates.