BEAS State Registry Consent Form

When completing the form, please include

• Employer information as: 
  • Your Name: North Country Healthcare
  • Your Email: nchvolunteers@northcountryhealth.org
• Prospective Employee 
  • Your Name: Your full name 
  • Your Email: The same email you used to create your account

See an example below:

Please complete the linked form here.

Copy will be sent to Your Email and nchvolunteers@northcountryhealth.org for review and approval.