Registration: Kind Clinic

If you have already registered for access to our online scheduling system and you have already received your welcome email message with your temporary password, please sign in using that password. 

If you have not completed this form, thank you for taking a moment to complete and submit the following details.

Thank you for your patience, it might take a few hours or days until your registration has been processed.


* required field
APPLICANT INFORMATION
 

General Information
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship

Personal Information
What is your date of birth?
Preferred Name
Do you identify as transgender?
What is your gender?
Male
Female
Non-binary/third gender
Prefer to self-describe
Prefer not to say
Other
Do you consider yourself a member of the Lesbian, Gay, Bi-sexual, and/or Transgender Community?
Yes
No
No but I identify as an Ally
Prefer not to say
What pronouns do you use? (check all that apply)
He/Him/His
She/Her/Hers
They/Them/Theirs
Zie/Zim/Zir/Zis
Other

Volunteer Information
What are your volunteer interests? (Check all that apply)
Community Outreach Advocate aka Kind Crew: Shares posts/stories/articles/THA events/etc on social media platforms to promote community awareness and understanding.
Event Volunteer: Helps to plan/staff/and execute THA social and fundraising events.
Open to assignments or administrative help at the main office.
What languages other than English are you fluent in?
T-Shirt/Sweatshirt Size
How did you hear about volunteer opportunities at the Kind Clinic?
If a staff member or volunteer referred you, who was it?

Please answer the following questions to the best of your ability:
Most people want to volunteer to give back to their community. What are your reasons for wanting to volunteer at the Kind Clinic?
By checking this box you certify that all responses to this form are true to the best of your knowledge. You also agree that all information may be verified by the Texas Health Action.
 Yes

We store cookies and other data on your device to help us deliver our services. By using Shiftboard, you agree to our use of cookies and confirm that you have read and accept our privacy policy.  



We appreciate your time and interest


 
 
Loading...
Loading...
Loading...
Getting help...

Error

×

×