Welcome to the Special Olympics Michigan Volunteer Website

Please fill out this form if you want to volunteer with us as a MEDICAL Volunteer for the 2017 State Poly Hockey Finals.

2017 State Poly Hockey MEDICAL

Special Olympics Michigan
2017 State Poly Hockey
November 11-12, 2017
Eastern High School, Lansing MI
MEDICAL VOLUNTEER REGISTRATION
** Must be 18 years old or above to volunteer for the Medical Staff
First name
Middle name
Family/last name
Comments
DOB
Gender
Home address
Line 1
Line 2
Zip/postal
City
State
E-mail
Phone
1. Professional Position
Physician
Nurse
EMT
Other (Specify)
Paramedic
Certified Athletic Trainer
Athletic Training Student
*please send/email a copy of your certification of license in your Medical Field (If you have not done so in the past)
Medical and Athletic Training Students, please list name of Clinical Supervisor
2. I have certificates in:
CPR
First Aid
AED
3. Have you had Special Olympics experience?
Yes or No
If yes, how many years?
4. I will be available on the following days:
Saturday, November 11th
Sunday, November 12th
**Housing is not available**