Volunteer

Volunteer

Coastal Medix offers volunteer opportunities for EMT, paramedic, nursing, and healthcare students looking to gain real-world event medical experience. Complete this form to get started.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
School or Program Name*
Level of Education*
If other, please let us know what field you're in*
Do you currently hold a CPR card?*

YESNO
Are you looking for specific school-required hours?*

YESNOJust to learn and have fun
What days/times are you typically available?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
What types of events interest you most?*

ConcertsFestivalsSportsCommunity EventsNo Preference
Do you have any comments or requests for the team?
Is there a specific event you're looking to volunteer at?
Please check if you'd like to be on our upcoming volunteer contact list.

Yes please add me to the announcement listNo thank you
EMERGENCY CONTACT
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Waiver & Acknowledgments
Volunteer Acknowledgment- I understand this is a volunteer, unpaid opportunity for educational experience and not a guarantee of employment.*

I understand
Confidentiality / HIPAA Acknowledgment - I agree to maintain patient confidentiality and follow Coastal Medix policies at all times.*

I Agree
Photo/Video Release - I give permission for Coastal Medix to take and use photographs and/or video of me during volunteer activities for marketing, training, and promotional purposes. I understand these images may be used on social media, websites, and printed materials. I also understand that choosing ‘No’ will not affect my ability to volunteer.*

Yes, I give permissionNo, I do not give permission
I acknowledge that volunteering with Coastal Medix may involve exposure to risks inherent in medical and event settings. I voluntarily assume all risks of injury, illness, or other harm that may occur while volunteering. I release and hold harmless Coastal Medix, its staff, and affiliates from any and all liability, claims, or demands arising out of my participation in these volunteer activities. I understand this opportunity is unpaid, educational, and does not create an employment relationship.
Signature*

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Volunteer

EMERGENCY CONTACT

Waiver & Acknowledgments