Bug Out Campout Medical Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

May 29-31, 2026 Anza, CA

Email *

May 29-31,2026 Anza, CA

First Name *

Last Name *

Pronouns *

Phone Number *

What city do you currently live in? (LA, SF, SD OC, etc) *

Date of Birth *

YYYY

Link to Facebook Profile *

Are you planning on volunteering with us at Bug Out Campout Medical/Sanctuary? *

Yes!

Unsure (If unsure, put your explanation in the "other" section, we need to know now, not later)

Other:

Certifications (CPR/FA, EMT, RN, MD, LCSW, LMFT, etc.) *

Previous medical/first aid/harm reduction experience *

Previous festival experience *

Previous festival medical/sanctuary/harm reduction experience (Have you ever done medical or sanctuary for a festival before? Which festivals? Which years?) *

Have you volunteered with RGX Medical before? *

Yes

Select what you are primarily applying for (we are all doing harm reduction, there is lots of crossover!)

Medical / First Aid / Logistics

Sanctuary/Sitting/Peer Support

Other:

Clear selection

Which day and time do you anticipate arriving onsite? *

Friday, May 29th, Noon

Friday, May 29th, Evening

Friday,May 29th, Night

Which day and time do you anticipate departing from site? *

Sunday, May 31st , Morning

Sunday,May 31st, Afternoon

Sunday, May 31st, Evening

Are you available for Pre/Post event Load/Strike in Burbank?

Are you planning on camping with us in RGX camp?

Yes

Other (If other, put your explanation in the "other" section, we need to know now, not later)

Other:

Clear selection

Briefly describe your camping set-up/footprint.

-You are allotted one 10x10 camping space in RGX camp and space for 1 vehicle in the parking lot. If you arrive pre-event, you will be able to drive to RGX camp and unload.

-There MAY be space for car camping in RGX camp. First priority goes to shift leads and then is based on number of RGX events you have volunteered for in the past.

-Email us if you would like to request to sleep in your vehicle in camp or have anything else outside of these parameters. If you do not get an email from RGX approving your car camping request, bring a tent.

Were you referred by someone, if so whom? If no, how did you hear about us? *

Emergency Contact and Relationship to You (e.g "Mother") *

Emergency Contact Phone Number *

Do you have any accessibility needs?

Anything else we should know? (This section is important. Please fill out anything relevant.) *

ALL emails should be sent to Logistics@RGXmedical.com AND CC'd to Richard@RGXmedical.com - Please add these emails to your address book. *

Got it!

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This form was created inside of The RGX Project.