COVID-19 Volunteer Sign-up Form
As South Dakota progresses on its COVID-19 vaccine distribution efforts, community volunteers will be needed.

If you would like to volunteer and/or learn more about how you can help vaccination efforts in your area, please complete the form below. As vaccination efforts and volunteer opportunities are expanded in your community, you will be contacted using the information provided.

Thank you and remember to stay strong, stay healthy!

-South Dakota Department of Health
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Full Name: *
Address:
City:
State (If other than SD):
Zip Code:
County: *
Email Address: *
Phone number: *
Distance willing to travel?
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When are you available to volunteer? (Check all that apply)
Are you willing to receive text message notifications about COVID-19 vaccination volunteer opportunities in your area?:
Clear selection
Would you like to be vaccinated before participating in any COVID-19 volunteer opportunities?
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What support are you able to provide? *
If Medical Support, do you have an active professional license?
Clear selection
License Expiration Date?
MM
/
DD
/
YYYY
If yes, what active professional license do you hold?
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What non-medical support are you able to provide?
Occupation:
Occupation Status:
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By checking this box, I indicate that I agree to the Terms of Service (https://volunteers.sd.gov/terms_of_service_popup.php) and have read and understand the Privacy Policy for this site. My submission of this form will constitute my consent to the collection and use of this information and the transfer of this information across the Internet to processing and storage facilities supporting this system. I also agree to receive required administrative and legal notices such as this electronically and understand and agree that required training prior to a volunteer opportunity is/may be required. *
Required
By checking this box, I pledge to provide only correct information when completing this registration process. I also give consent to Statewide Emergency Registry of Volunteers in South Dakota and their designated agents to collect, use, verify, and maintain any information that is collected through the use of this site. *
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