Judges Vetting

Volunteer Emergency Contact & Medical Info

This information will not be distributed outside the Miss Oregon Executive Staff and will only be used in case of an emergency during pageant week.
Full Name*

First NameLast Name
Email address*
example@example.com
Volunteer Position

Competition JudgeProduction VolunteerSecurity VolunteerLocal DirectorMOSP Staff
Cell Phone Number*
Lodging arrangement/Home for competition week*
I will be arriving on:

MonthDayYear
Date
Travel Companion name, if applicable
Travel Companion Phone Number
Physician's name*
Physician's Phone Number*
Please list the name and phone number of any person, besides your travel companion or physician, whom we should contact on your behalf in case of an emergency.
Emergency Contact Name*
Emergency Contact Phone Number*
Any allergies, including medications or foods
Rx or over-the-counter medications routinely taken
Any health or medical issues you would like us to know about
Insurance Provider*
Upload Insurance Card*

Browse Files
A screenshot of your card will suffice. JPG or JPEG, PNG or PDF format, please. Cancelof
Any other specific instructions or notifications
NOTE: If there is any additional information that you think our staff should be aware of relative to your safety or health, please feel free to request a personal conversation with our Judges Chair, Executive Director, Security or Medical Staff. All conversations will be handled professionally and confidentially.

Thank you for taking the time to be a part of our competition. The safety and well-being of all our volunteers is of the utmost importance to the Miss Oregon Scholarship Program and we appreciate you completing this form to help us ensure that we are all safeguarded and well taken care of during our time of service to this organization.
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Volunteer Emergency Contact & Medical Info