Full name (as it appears in your passport or ID) First name you like to be called (if different) Email Date of birth Mobile phone number (include full international dialing code) Location you will come from (city, country) Do you agree to your name and phonenumber being shared with other volunteers and FAST coordinators? Yes No Please explain why you want to volunteer with FAST? Please describe your first aid experience and any other relevant skills you hold. We require first aid experience, with wound management in particular. Please provide a name, work email address and job title of someone who can provide a brief reference for you to confirm your first aid skills and suitability What type of healthcare professional are you? (Choose the most senior qualification) Medical doctor Nurse Paramedic/EMT First aider Dentist Pharmacist Student nurse Student medic Other Date of qualitifcation Professional registration number If you are a medic or nurse, have you checked that your medical / nursing indemnity insurance provider will cover you for first aid in France? Yes No Will you bring a car to Calais? Yes No Have you figured out accommodation in Calais already? Please let us know if you have difficulty Yes No Have you volunteered with FAST before? Yes No Have you volunteered with refugees, or in similar circumstances before? Please explain if so. Have you got comprehensive travel health insurance for your trip? Are you medically fit and well? Possible start date Possible end date I have the legal right to volunteer in Europe (FAST cannot help you with visa applications) Yes No I understand that FAST only uses my personal information to process my application and for communication about the volunteering Yes, I agree No, I do not agree I agree to comply with FAST's Code of Conduct Yes No I acknowledge that all costs associated with the volunteer placement will be borne by me Yes No As a volunteer from the healthcare profession: I understand the risks and dangers of humanitarian work and will make no claim for any form of compensation from the organizers. I undertake to respect my professional code of ethics and to maintain impartiality from all political, economic or religious persuasions. I have completed the above information sincerely and truthfully, and agree that my application will not be complete until all supplementary information has been submitted as requested. Send