Envision Festival 2019 Medical Volunteer Application
Welcome! Spots are limited so we need your info ASAP.
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
What city, state, country do you currently live in? *
Your answer
Date of Birth *
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DD
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YYYY
Link to Facebook Profile URL *
Your answer
Are you planning on volunteering for Envision Medical? *
Level of Certification (CPR/FA, EMT, RN, MD, LCSW, MFT, etc.) *
Your answer
Previous medical/first aid experience *
Your answer
Previous festival experience *
Your answer
Previous festival medical experience (Have you ever done medical for a festival before? Which?) *
Your answer
Have you been to Envision before? What years? Did you volunteer? *
Your answer
Have you volunteered with RGX Medical before? *
Which day and time do you anticipate arriving onsite? *
PRE-EVENT - We need 2 medics starting as early as February 1. We need a small team starting February 20th-23rd. Are you available? Are you interested? Answer below! *
Your answer
Which day and time do you anticipate departing from site? *
Are you available to arrive early to assist with setup or stay late to assist with breakdown? *
Please list your available arrival and departure dates in the "Other" section
I understand that I need a passport with a minimum of 6 months of validity to travel into Costa Rica. *
Required
I currently: *
Are you planning on staying on-site at Envision Festival?
If you are camping with medical, please briefly describe your camping set-up/foot print. (For example, camping in a 4 person tent) *
Your answer
Spanish fluency (not required) *
Were you referred by someone? Who? *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Anything else we should know? (this section is important. Please fill out anything relevant.) *
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