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Volunteer Application

Sidelines Volunteer Application Form

Please fill out the following form if you want to be an email or phone volunteer for Sidelines. This information is kept confidential and will be used to help us match you with future high-risk moms you support. Please note: You must be at least 18 years of age to become a Sidelines volunteer.

If you do not receive a reply to your application in 5 business days, please email Tracy Hoogenboom, Director.

Volunteer Application Form

First Name
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Last Name
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Email Address
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Email Address (retype)
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Home Phone
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Cell Phone
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Date of Birth
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Address
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City
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State or Province
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Zip Code
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Country
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How did you find out about Sidelines?
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Did you read "Who Are the Volunteers?"
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Are you currently pregnant?
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Have you been formally trained by Sidelines before?
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If yes, please indicate the year you were trained:
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If Sidelines supported you during your high-risk pregnancy, please provide your volunteer's name:
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Did the volunteer provide the support you needed during your high-risk pregnancy?
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Please explain.
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Why do you want to be a volunteer for Sidelines?
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I prefer to provide support by:
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Do you answer your emails quickly (no more than 48 hours after receipt)?
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Your Occupation:
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How many children do you have?
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How many high-risk pregnancies have you had?
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Pregnancy Complications 
 (Check all that apply to your past pregnancies)

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Depression
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Infection (Please Check Types)
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Multiple Gestation
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Did you have a pregnancy as the result of infertility management?
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Fertility Treatments (Check all that apply)
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Types of Treatments (Check all that apply to your past pregnancies)

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Activity Restriction/Bed Rest
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fFn (Fetal Fibronectin)
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Amnisure/Rupture of Membranes
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Medications (Check all that apply to your past pregnancies)

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Progesterone
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If you could choose ONE primary pregnancy complication you experienced, it would be: (check box below)
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Did you have a preterm delivery? (less than 37 weeks gestation)
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If yes, how many weeks?
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Did you have a baby in the NICU?
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If yes, length of NICU stays:
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Other treatments or medications not sited above:
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Please give a brief synopsis of each of your pregnancies:
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Special areas of interest or expertise:
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Any area you do not feel comfortable dealing with?
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Additional comments:
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Do you have any professional skills/services you would like to donate to Sidelines? Please list your skills:
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Note: When you click "submit", your information is automatically sent to Sidelines via email. If you have problems using this form, email us with this information to sidelinesonline@comcast.net.

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