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678-625-8317

For life-threatening emergencies, call 911

Free medical care for

Newton, Jasper, and Walton Counties

GOLF TOURNAMENT

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Volunteer Application

Please fill out the form below if you are interested in volunteering with Willing Helpers Clinic. We will get back with you within 24-48 hours with more information. Thank you for your interest in caring for our patients!

First name

Last name

Email

Address

Birthday

Which position are you interested in?

Clerical

Spiritual Care

Medical

Other

Are you a U.S. Citizen?

No

Yes

Have you ever been convicted of a felony?

No

Yes

If you answered yes to the last question, please elaborate:

Are you a current student? If so, what school?

Do you attend church regularly?

Yes

No

Employment/volunteer work experience (current and/or previous)?

Personal references (2 required with name, contact info, and relationship to applicant):

Electronic Signature - by typing your name below you agree that you have answered honestly and to the best of your abilities:

Thanks for submitting!

4186 Mill Street NE

Covington, GA 30014

678-625-8317

For Life-Threatening Emergencies Call 911

For I was sick and you looked after me... Matthew 25:35-36

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© 2023 by Willing Helpers Clinic, a 501c3 non-profit organization.

EIN: 56-2602392

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