Sunset Campout 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 do you currently live in? (LA, SF, SD, Orange County, etc) *
Your answer
Date of Birth *
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DD
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YYYY
Link to Facebook Profile *
Your answer
Are you planning on volunteering for RGX Medical at Sunset Campout? *
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 volunteered with RGX Medical before? *
Which day and time do you anticipate arriving onsite? *
Which day and time do you anticipate departing from site? *
Are you planning on camping with medical camp?
If you are camping with medical, please briefly describe your camping set-up/foot print. (For example, camping in a 4 person tent with a 10'x10' pop-up) *
Your answer
Were you referred by someone? If yes, who? *
Your answer
Emergency Contact Name, Relationship (i.e. Jane Doe, Mother) *
Your answer
Emergency Contact Phone Number *
Your answer
Anything else we should know? (this section is Important!) *
Your answer
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