2014 Selway Bitterroot Wilderness Volunteer Projects Registration

Thank you for your interest in volunteering with the Selway Bitterroot Frank Church Foundation. Please complete the following questions as completely as possible for each individual signing up for the project (sorry no group registration). We will review the information you have provided us and get back to you with additional information about the project(s) you have registered for. If you have any questions about this registration page or for more information about a project please contact the Selway Bitterroot Frank Church Foundation Region 1 Programs Director, Coby Gierke, at 503 679 2568 or by email at cgierke@selwaybitterroot.org

1. Please provide us with the following contact information:

First Name *This question is required.

Last Name *This question is required.

Title

Company/Organization

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Postal Code *This question is required.

Country *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required. This question requires a valid number format.

Fax Number This question requires a valid number format.

Mobile Number This question requires a valid number format.

2. Selway Bitterroot Frank Church Foundation volunteers must be at least 18 years of age or older, or accompanied by a parent or guardian. Please select one of the following which best describes you:

3. If under 18 years of age, please list the name of parent(s) or guardian(s) who will be accompanying you.

4. Please select the project(s) you are interested in volunteering for.

5. Please select the type of work you would like to volunteer to do (feel free to check multiple boxes)

Wilderness Stewardship (trails, weed eradication, monitoring, restoration, ect)
Horse/Mule Packing
Camp Chef
Cabin Host or Lookout Caretaker
Other Crew Support (boating, bush flights, off road vehicle, crew shuttles, ect.)
Office and Professional Support (website improvements, social media, online communications, legal aid, fundraising, other professional services)

6. If you don't see any projects that will work for you but you are still interested in volunteering with the Selway-Bitterroot Frank Church Foundation, please list the dates you are available for and we will do our best to get you out in the field with our crews.

7. We prefer that you stay with us for the full duration of the project, from start to end. Are you available for the full duration of the project(s) that you are registering for? (Registration preference is given to volunteers who can stay for the full duration of a project.)

8. If you are not available for the full duration of the project please tell us what dates you are available for. *This question is required.

9. Do you have friends, family, or others that are also registering for any of these projects? (Please note, they will need to fill out a registration with us as well.) If so, please list their name(s) here so we know that you want to be on the project together!

10. Have you volunteered with the Selway Bitterroot Frank Church Foundation before?

11. If you have volunteered with us before, please tell us when and which project you helped out on.

12. Following are several questions about your medical/physical condition. This is kept private by the Selway Bitterroot Frank Church Foundation leader(s) on-site so that we know if there are medical things we should be aware of about you. *

Gender
Age
Height
Weight

13. Do you carry health insurance?

14. Insurance Provider Information

Insurance Company
Policy Number
Insurance Company Phone Number
Doctor's Name
Doctor's Phone Number
Location of Doctor's Office

15. Please describe anything that you are allergic to and the type of reaction that you have when that allergy is triggered:

16. Please describe any injuries or medical conditions that could give you some discomfort while engaged in strenuous physical activity above 9,000 ft. (e.g. recent surgeries, back/knee/joint pain/issues, strains/sprains, etc) If none, simply enter "none" or "n/a".

17. Have you had a tetanus shot or booster within the last 10 years?

18. Are you currently using any medication that your Crew Leader should know about? If so, please list the medication(s), reason for use, any symptoms from under-dosage or over-dosage, and any potential negative interactions with other medications or substances. If none, simply enter "none" or "n/a". *This question is required.

19. Food Preferences/Needs: (Select all that are applicable.)

20. Following are a few questions about your outdoor experience and physical fitness. To start off with, please briefly describe your overall physical fitness/condition, including physical activities that you regularly participate in: *This question is required.

21. How do you feel about your level of physical fitness to hike up to 15 miles per day, carry a backpack, and do physical work above 8,000 feet in elevation? (A good gauge of physical preparedness for Selway Bitterroot Frank Church Foundation projects is: if you are reasonably fit enough to do a full day of outdoor recreation such as hiking, skiing, whitewater rafting, cycling, etc, then you are likely fit enough for a project with us.) *This question is required.

22. Which of the following describes your experience with camping, backpacking, etc?

Car camping - give me a lawn chair, my own 6-person tent, and the full-size cook stove and I'm happy.
I've been backpacking a few (1-5) times.
I've been backpacking more than 5 times.
Never been camping before

23. Do you have any camping experience in bear country? *This question is required.

24. Emergency Contact Information

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number:
Alternate Phone Number:
Relationship:

All participants must complete this form including the e-signature. For Participants under 18 years of age, one parent or legal guardian must also sign. Selway-Bitterroot Frank Church volunteers may be covered for tort claims and injury compensation by the U.S. Forest Service under the Selway-Bitterroot Frank Church Foundation's sponsored volunteer agreement with the U.S. Forest Service. Tort and injury coverage are conditional upon volunteers working within prescribed safety limits and protocols. At the beginning of each project a Job Hazard Analysis document, which reviews safety concerns and protocols for the project, will be reviewed with all participants. Each participant must sign the Job Hazard Analysis document after the pre-project review. Refusal to signs the document will result in dismissal from the project. The Selway-Bitterroot Frank Church Foundation reserves the right to remove any participant from a project for any reason. By affixing your e-signature to this form, you acknowledge that you have carefully read and understand this form. By affixing your e-signature to this form you also authorize the Selway-Bitterroot Frank Church Foundation to use your/or your child's photo for sale or reproduction in any manner that the Selway-Bitterroot Frank Church Foundation desires, for advertising, display or other uses.

25. ACKNOWLEDGEMENT: I have filled out this information thoroughly and to the best of my knowledge. In respect to those who have donated financially to fund the Selway-Bitterroot Frank Church Foundation's expenses towards these volunteer projects, I will do my best to commit to registering for this project, and will notify SBFC immediately if I must cancel my registration.

E-Signiture
Date
Parent/Guardian E-Signiture
Date

26. Please upload your signed volunteer registration page.

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2014 Selway Bitterroot Wilderness Volunteer Projects Registration

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