Welcome to the Special Olympics Michigan Volunteer Website

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

2018 State Winter Games MEDICAL

2018 State Winter Games
Special Olympics Michigan MEDICAL
January 30th - February 2nd, 2018
First name
Middle name
Family/last name
DOB
Gender
Comments
Home address
Line 1
Line 2
City
State
Zip/postal
E-mail
Home phone
Mobile
Employer
I would like to participate in the medical coverage for the State Winter Games
Please check the appropriate items below:
1. Professional Position
Physician
Nurse
EMT
A.T.C
Paramedic
Student Athletic Trainer
Other (Specify)
2. Are you personally insured for liability?
Yes or No
3. I have certificates in:
CPR
Standard First Aid
Advanced First Aid
4. Have you received the Hepatitis B series of vaccinations?
Yes or No
If yes, please indicate dates:
Vac 1
Vac 2
Vac 3
Winter
5. Have you had Special Olympics experience?
Yes or No
Summer
If yes, how many years?
Fall
Tues. Jan 30th
Wed. Jan 31st
6. I will be available on the following days:
Thurs. Feb 1
Fri. Feb 2
7. I would prefer to work
Inside
Outside
8. I would like to volunteer for night duty - 10:00pm - 7:00am (1 night)
Tues.
Wed.
Thurs.
9. Please check if you need housing or meals:
Tuesday
Housing:
Wednesday
Roommate preference
Thursday
Fri. Breakfast
Meals:
Tues. Dinner
Wed. Breakfast
Thurs. Breakfast
Wed. Lunch
Thurs. Lunch
Fri. Lunch
Wed. Dinner
Thurs. Dinner
10. Can you bring equipment? Please specify...
11. Will You arrive before 1pm on Tuesday?
Yes or No
12. Would you like to volunteer in Med Fest?
Yes or No
Mike Martin, Med Staff Coordinator
Special Olympics Michigan
Central Michigan University
Mt. Pleasant, MI 48859