Trauma Camp Volunteer Registration

Want to know more information about Trauma Camp before you register? Click here!

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

All Trauma Camp volunteers must be at least 14 years old BY the day of Trauma Camp. Volunteers under the age of 18 will need to have a parent or legal guardian signature.

Volunteers will need to be on site most of the day on Saturday. Specific instructions will be communicated. 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.

PERSONAL INFORMATION

Name

First Name

Last Name

Date of Birth

Volunteers must be at least 14 years old on the date of Trauma Camp. Volunteers under the age of 18 will need to have a parent or legal guardian signature upon arrival at Trauma Camp.

YYYY

Phone

(###)

###

####

Email Address

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

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

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Emergency Contact Phone Backup

(###)

###

####

Allergies

Current Medications

Medical History

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.

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