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 Winter Games MEDICAL

2019 State Winter Games
Special Olympics Michigan MEDICAL
January 29th - February 1st, 2019
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 29th
Wed. Jan 30th
6. I will be available on the following days:
Thurs. Jan. 31st
Fri. Feb 1
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
Thursday
Roommate preference
Tues. Dinner
Wed. Breakfast
Thurs. Breakfast
Fri. Breakfast
Meals:
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