Gerald Island April 2024 | Medical Form

Gerald Island Fall 2026 | Volunteer Medical Form

Please complete this form prior to your arrival to Gerald Island. Our stewardship team will be notified once the form is completed.

Please note that med forms for participants under the age of 19 years old must be filled out by the same parent / guardian who completed a waiver for the participant.

Volunteer's Name *

First

Last

Volunteer Birth Date *

Email *

Sex *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Emergency contact (inc. name, phone number, and relationship) *

DOCTOR'S DETAILS

Doctor Name *

First

Last

Doctor's Healthcare Facility Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

MEDICAL HISTORY

Are you curently receiving medical treatment? *

Are you currently taking any medication? *

Have you ever suffered a serious illness or injury? *

Do you have any allergies? *

Please include all allergies - medications, foods, stings, etc.

Do you have any other relevant disabilities or conditions not mentioned above? *

Have you had medical care in the last three months? *

Date *

Gerald Island Fall 2026 | Volunteer Medical Form

DOCTOR'S DETAILS

MEDICAL HISTORY

About

Find

Join Our Community

Get the latest marine recreation & conservation news. Please put in your first and last name plus email to receive our newsletters.

3285 Roper Road
Ladysmith, BC, V9G 1C4
Contact Us

We are a nonprofit organization and a registered charity (CRA number: 812142826RR0001). Income tax receipts will be issued by Canada Helps upon donation.

Gerald Island Fall 2026 | Volunteer Medical Form

DOCTOR'S DETAILS

MEDICAL HISTORY

About

Find

Join Our Community

Get the latest marine recreation & conservation news. Please put in your first and last name plus email to receive our newsletters.

3285 Roper RoadLadysmith, BC, V9G 1C4Contact Us

We are a nonprofit organization and a registered charity (CRA number: 812142826RR0001). Income tax receipts will be issued by Canada Helps upon donation.

3285 Roper Road
Ladysmith, BC, V9G 1C4
Contact Us