mission of mercyVolunteer

There are many ways you can volunteer in the Mission of Mercy. We need your energy, your time, your skills and talents. We especially need volunteers to help with set up and tear down. Also, dentists are needed for Thursday afternoon and Saturday afternoon. volunteers


You may fill out the online registration form below or download the form as a Word doc and return to us.

Volunteer Registration form

title First Middle Last suffix cred. 

  Address:


    City:   State: Zip:

Affiliation:

  Phone:     E-mail:  

Volunteer type
General   or Clinical

Availability 
Thursday, June 21 Friday, June 22 Saturday, June 23
Set-up operations:
unload assemble, etc.

6 a.m. - 12 noon
12 noon - 6 p.m.

 6 a.m. - 12 noon
12 noon - 6 p.m.

 6 a.m. - 12 noon
12 noon  - 6 p.m.
Teardown crew, Saturday 
5-8 p.m. Yes, sign me up to be a part of the "teardown" crew to disassemble, pack and load trucks, among other things
Flexible Schedule?
Check here if you are willing to have your schedule changed so you can be here when you are most need. We of course will contact you to make arrangements! (Note: please still select an initial schedule.) 

Orientation
Check here if you can attend the orientation session at 6 p.m. on Thursday, June 21

For clinical volunteers only (with a license) I am a.....
Dentist  Physician
Nurse Hygienist 
Dental Assistant Physician's Assistant 
Nurse Practitioner Other     Specify:

I want to serve in the following capacities:
Dental Hygiene Dental Triage
Oral Surgery Endodontics
X-Rays Patient Recovery
Dental Assistant Instrument Sterilization
Medical Screening Restorative Dentistry

License Information

    License #   State Date:

Serving as a team

We make an effort to keep practice members together. 

Practice Name 
Doctor/assistant pairs enter each other's names here:
(In all cases each team member or assistant must complete his or her own volunteer form.)


Non-Maryland dentists and hygienists must apply for a temporary volunteer Maryland license. Please download the form, complete it and mail at your earliest convenience.  Thanks!
T-shirt size

clinicFor questions or concerns about volunteering, please contact the Volunteer Director:

Dr. Stephen Dargan
Phone:  410-535-4050
E-mail: dargandds@yahoo.com

 

 For a Word doc or pdf of the registration form, please contact us via e-mail.

 

smmom