First Aid Support Team Registration form
Thank you for taking an interest and applying to work with First Aid Support Team.

Please complete all sections fully. The questions marked with * are compulsory

Full name: *
Please complete as it appears in your passport or ID document ?
Your answer
Name on Facebook: (We do all ground communication on Facebook, so please check your messages!) *
Your answer
Date of birth: *
MM
/
DD
/
YYYY
Telephone *
(Include full international dialing code)
Your answer
E-mail *
Your answer
Skills and Qualifications
What type of healthcare professional are you? *
Choose the most senior qualification
Transportation and accomodation
Here we will ask you a couple of questions about accomodation and transportation in Calais. You will receive more info about the FAST-room and car after you have signed up
Do you bring a car to Calais? (Please be aware that it is almost impossible to work with FAST without a car) *
If you are bringing a car. Can you take other FAST volunteers in your car? If so, how many?
Have you figured out accomodation in Calais already?
Do you have a prescribing licence? *
Date of Primary Qualification *
MM
/
DD
/
YYYY
Professional registration number *
Your answer
Relevant experience or skills?
Have you got suitable medical indemnity (legal defence) cover (humanitarian worker)? *
Have you got travel health insurance? *
Are you medically fit and well? *
When are you coming?
Please be sure that the dates are right. When you are not sure yet, but do want some more info; please send an email to nynke@f-a-s-t.eu
Arrival Date *
MM
/
DD
/
YYYY
Departure Date *
MM
/
DD
/
YYYY
Notes
Please use this section to add additional notes about any of the above questions.
Your answer
I understand that FAST only uses my personal information to add me to the teamchat and rota. Also FAST will do a short registration check. After volunteering FAST will delete my personal information. *
As a volunteer from the healthcare profession, *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service