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CM MBC STAFFVOLUNTEER MEDICAL FORM 2390 Horse Hollow Rd., Jonesville, VA 24263 2763461013 www.cmmbc.org Name: Gender: M / F Date of Birth / / Address: City State Zip Select the purpose of your volunteering:
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How to fill out staff-volunteer medical form

01
Read the form carefully and make sure you understand all the sections.
02
Start by providing your personal information such as your name, address, date of birth, and contact details.
03
Fill out the section for emergency contact information, including the name, phone number, and relationship of the person to be contacted in case of an emergency.
04
Provide details of your medical history, including any chronic conditions, allergies, or medications you are currently taking.
05
Answer all the questions relating to your physical and mental health honestly and accurately.
06
If there is a section for vaccinations, list the vaccines you have received along with the dates.
07
Check if any additional documentation is required, such as a doctor's note or medical clearance.
08
Review the completed form to ensure all the information is correct and legible.
09
Sign and date the form to certify that all the information provided is true and accurate.
10
Submit the form to the appropriate authority or organization as instructed.

Who needs staff-volunteer medical form?

01
Any staff or volunteer who will be involved in activities that may pose a risk to their health or require medical attention should fill out the staff-volunteer medical form.
02
Organizations or institutions that prioritize the well-being and safety of their staff and volunteers may require the completion of this form.
03
Examples of individuals who may need to fill out the form include volunteers working in healthcare settings, summer camp counselors, event organizers, and sports coaches.
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The staff-volunteer medical form is a document that collects medical information from individuals who are volunteering or working for a specific organization.
All staff and volunteers are required to file the staff-volunteer medical form.
The staff-volunteer medical form can be filled out by providing accurate and complete medical information as requested on the form.
The purpose of the staff-volunteer medical form is to ensure that individuals volunteering or working for an organization are medically fit to perform their duties.
The staff-volunteer medical form typically requires information such as medical history, current medications, allergies, and emergency contact information.
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