Volunteer Registration Form
One-day event: Unwanted Household Medication Disposal Event
Date: Saturday, April 27, 2013 from 10am-2pm
Locations: TCAT, 737 Willow Ave., (off Rte. 13), Ithaca
Slaterville Fire Hall, 2681 Slaterville Rd, Slaterville Springs
Sponsored by: Coalition for Safe Medication Disposal in conjunction with the DEA’s National Take Back
We need volunteers (at least 16 years old) for traffic control, greeting, sorting, and data entry at our seventh Household Medication Disposal Event.
§ Traffic control volunteers direct cars at entry and exits, and through the collection site.
§ Greeters welcome drivers as they pull in, advise them of the procedure, and ask survey questions.
§ Sorters either will go through turned in medications, remove outer packaging for recycling and separate over the counter from prescription medications or be responsible for recycling tasks such as sorting paper/plastic, marking out names, etc.
§ Data entry volunteers input survey answers or drug collection data into laptop computers
A Safety and Job briefing for staff and volunteers will be given the day of the event.
Need to know more about the event? Call 2-1-1 or visit www.healthyyouth.org
Name (please print):
Address:
E-mail: Phone:
May we keep your application on file for our next event? Yes No
I would like to volunteer as: greeter traffic control sorter data entry wherever needed
If you have experience as a pharmacist, nurse, or physician, would you help with inventorying controlled substances? Yes No
I can volunteer on 04/27/13 for the following (circle one or more):
TCAT 9:30am – 1:00pm TCAT 12:30 noon – 3:00pm
Slaterville 9:30am – 2:30pm
I can volunteer at TCAT to assist in clean up after 3:00 if needed Yes No
We will be counting on you!
If you can't be there, please notify the RSVP office as soon as possible.
Send completed application to
Volunteer Registration Form
RSVP at Lifelong Phone: 607-273-1511
121 W. Court St Email:
Ithaca, NY Fax: 607-272-8060
Volunteer Registration Form
You will be asked to sign this waiver when you arrive, if have not submitted with your registration form.
F:\RSVP\Station Support\Safe Rx Disposal Events\April 2013 Volunteer Form.DOC