Trauma Camp Volunteer Registration

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Complete the following form to register as a VOLUNTEER for Trauma Camp 2019.  All fields are required.

All Trauma Camp volunteers must be at least 14 years old on SEPTEMBER 21, 2019.

Volunteers will need to be on site during the afternoon of Saturday, September 21. A specific arrival time will be communicated at a later date. Location is the Bartholomew County 4-H Fairgrounds in Columbus, Indiana. Volunteers are welcome to arrive earlier in the day to observe the other Trauma Camp activities. You will be require to sign a consent form and waiver when you arrive. Volunteers under the age of 18 will need to have a parent or legal guardian signature.

 
PERSONAL INFORMATION
Name *
Name
Date of Birth *
Date of Birth
Volunteers must be at least 14 years old on October 13, 2018. Volunteers under the age of 18 will need to have a parent or legal guardian signature upon arrival at Trauma Camp.
Phone *
Phone
Home Address *
Home Address
EMERGENCY INFORMATION
The information provided in this section is for use in case of an emergency and will be utilized only by Trauma Camp administrators and medical staff involved in your care should an emergency occur. If you are under the age of 18, the emergency contact listed MUST be your parent or legal guardian.
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Emergency Contact Phone Backup
Emergency Contact Phone Backup
CONFIRMATION
By checking this box and submitting this registration form, I certify that the information I have provided on this form is true, accurate, and complete. *