Volunteer Registration - Online

Name *

First Name

Last Name

Phone *

Please enter the phone number you'd like us to use when we call.

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you volunteered with Reeling & Healing Midwest before?

Yes

No

What Type of Retreat Volunteer Position do You Prefer? *

Check all that apply

Land Volunteer - Full Retreat

Land Volunteer - Portion of the Retreat

River Guide Helper or Instructor - Full Retreat

River Guide Helper or Instructor - 2nd & 3rd Days

River Guide Helper or Instructor - 2nd Day Only

Combination of Land Volunteer & River Guide Helper - Full Retreat

I'm uncertain. Let's discuss.

Do you have any prior fishing or fly fishing experience, or certification in First Aid, CPR, or related courses? *

Seeing "A River Runs Through It" does not count. However, it does earn you a special prize!

Yes

No

Bring on the Trout!!

First Aid or CPR

First Retreat Choice *

New Participants - August 4th-6th

New Participants - August 11th-13th

New Participants - August 18th-20th

New Participants - August 25th-27th

Second Choice *

New Participant - August 4th-6th

New Participant - August 11th-13th

New Participant - August 18th-20th

New Participant - August 25th-27th

None

Third Choice *

New Participants - August 4th-6th

New Participants - August 11th-13th

New Participants - August 18th-20th

New Participants - August 25th-27th

None

Fourth Choice

New Participants - August 4th-6th

New Participants - August 18th-20th

New Participants - August 18th-20th

New Participants - August 25th-27th

None

COVID-19 Vaccination *

All Volunteers must be fully vaccinated (two shots + booster) by their retreat date. Proof of vaccination may be requested

Yes, I will be fully vaccinated and have received at least one booster by my retreat date.

No, I will not be fully vaccinated.

I am over 18 years of age. *

Yes

No

Do you Have Any Allergies or Sensitivities? *

We like to make a safe and comfortable environment for everyone. Options selected below will be discussed with the retreat coordinator.

Food

Medication

Environmental

Chemical

Insects

Carry Epi-Pen

None

Any Current Health Issues, Physical Restrictions or Special Needs? *

These will be reviewed with the retreat coordinator.

COPD/Asthma

Diabetes

High Blood Pressure

Afib/Stroke

Orthopedic/Neuropathy

Seizures

Physical Limitation(s)/Restriction(s)

Healing Surgical Wound or Open Port Line

Other

None

Do You Think You Can... *

-Ascend and descend 20 stairs at least 10 times a day. -Climb up and down an outdoor trail and river/stream bank. -Wade comfortably with stability for extended periods of time in a river or stream -Capable of walking by self on even and uneven terrain, able to sit or stand for periods of time -Lift and cast a fly rod -Have good verbal and non-verbal communication skills -Lift and move objects and boxes from 5-40 lbs through the duration of the retreat -Securely assist and, if guiding, support/assist an individual of up to 165lbs while wading in the river by self or with another volunteer. -Stand and walk without pain and/or use of a cane/walker.

Yes

Maybe

No

Emergency Contact Phone *

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First *

I have completed the above information and acknowledge it true. I acknowledge that I am a voluntary volunteer and I agree to assume responsibility for myself. I understand misrepresentation or omission of facts requested is cause for dismissal of my request as a Reeling & Healing volunteer. If appointed as a volunteer, I agree to adhere to the general policies and guidelines set forth by Reeling & Healing Midwest and to fulfill my volunteer responsibilities to the best of my ability.

I Acknowledge

Second *

I acknowledge that the Reeling & Healing Midwest volunteers are not to provide medical or psychological diagnosis, treatment, opinions, referrals, guidance, assistance, or counseling to anyone specifically and that are present for the purpose of facilitating involvement and not to provide professional services to group participants. I understand that reasonable measures will be taken to safeguard the health and safety of all participants and volunteers, and that my emergency contact will be notified as soon as possible in case of an emergency. In the event they cannot be reached, I hereby authorize Reeling & Healing Midwest to acquire medical treatment for me.

I Acknowledge

Third *

I further agree to waive any claims against Reeling & Healing Midwest, its officers, employees, agents, volunteers or participants resulting from any and all losses, damages, costs and expenses that are caused by or arise out of any act, omission, default, negligence or other misconduct by Reeling & Healing Midwest in connection with my volunteer participation.

I Acknowledge

I Understand This Is Just the First Step *

Remember, submitting this information does NOT represent an official registration or confirmation to volunteer. This is the First Step. After you submit this form you will receive: 1) A confirmation of submission. 2) An email containing a Retreat Guidelines & Agreement Form to be initialed, signed, and submitted via Adobe DocuSign. 3) If applicable, an email request from Stripe for your Retreat Commitment Fee payment. 4) Contact from a Retreat Coordinator.

Yes. I understand this is the First Step and there are more to complete, as well as contact with a Retreat Coordinator