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ABOUT QVHD

COMMUNITY

ENVIRONMENTAL

EMERGENCY PREPAREDNESS
- Volunteer Information
- CT Guide to Emergency Preparedness
- 9-1-1 Special
Needs Form
- Storm Preparedness
- Pandemic Flu Information
- Information for Persons with Disabilities or Special Needs
- Information for Pet Owners
- Are you ready?

MOM'S CLINIC

RESOURCES

Quinnipiack Valley Health District
Public Health Volunteer Registration Form

If you are interested in volunteering please fill in the online form below. The clinic sites are in Hamden, North Haven and Woodbridge.

STEP 1: Enter Contact Information
NAME:
STREET:
TOWN:
ZIP:
DAY PHONE:
EVENING PHONE:
FAX:
CELL/PAGER:
EMAIL:
If you speak one or more languages other than English, please list them
STEP 2: Please Indicate Interest
First Choice Second Choice   NO PREFERENCE ANYWHERE NEEDED VOLUNTEER COORDINATOR GREETER EDUCATOR VIDEO/ORIENTATION REGISTRATION STAFF FORMS COLLECTOR CLINIC FLOW CONTROLLERS SECURITY TRANSPORTATION/PARKING FLOAT STAFF MEDICAL RECORDS COMPUTER TECH DATA ENTRY REFRESHMENTS TRANSLATORS

Pre-clinic training will be provided. Length may be modified by an emergency event.

Print and Mail Form

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Quinnipiack Valley Health District
1151 Hartford Turnpike
North Haven, CT 06473

Phone. (203) 248-4528
Fax. (203) 248-6671
E-Mail. info@qvhd.org