Welcome to the Special Olympics Michigan Volunteer Website

Please fill out this form if you want to volunteer with us as a MEDICAL Volunteer.

2019 State Summer Games MEDICAL

Special Olympics Michigan
2019 State Summer Games
May 30th - June 1st, 2018
CENTRAL MICHIGAN UNIVERSITY
MEDICAL VOLUNTEER FORM
** Must be 18 years old or older to volunteer for the medical staff.
First name
Middle name
Family/last name
Comments
DOB
Gender
Home address
Line 1
Line 2
City
State
Zip/postal
E-mail
phone
Please check the appropriate items below:
1. Professional Position
Physician
Nurse
Certified Athletic Trainer
Paramedic
EMT
Athletic Training Student
Other (Specify)
*please attach a copy of your certicication of license in your medical field.
Medical and Athletic Training Students please list name of clinical supervisor:
2. I have certificates in:
CPR
First Aid
AED
3. Have you received the Hepatitis B series of vaccinations?
Yes
No
Have you refused the vaccinations?
Yes
No
Signature
Date
4. I will be available on the following days:
Thursday, May 30th
Friday, June 31st
Saturday, June 1st
If you are not available for the entire day, list hours of availability:
5. Please check if you need housing:
Housing will be provided in the Residence Halls.
Thursday, May 30th
Friday, May 31st
Roommate preference:
6. I would like to be a team leader/assistant team leader.
Yes or No
7. Have you ever volunteer on the Special Olympics medical team before?
Winter
If yes, how many years?
Summer
Fall
If no, how did you hear about this opportunity?