Full Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which week(s) would you like to volunteer for? *

Please check your preferred weeks for volunteering. If you select more than 1, we will assume that you are happy with either week.

(Weeks 1-4; early field season volunteering opportunities to be determined)

Week 5 (May 10-May 17, 2024)

Week 6 (May 17-May 24, 2024)

Week 7 (May 24-May 31, 2024)

Week 8 (May 31-June 7, 2024)

Week 9 (June 7-June 14, 2024)

Week 10 (June 14-June 21, 2024)

Week 11 (June 21-June 28, 2024)

Week 12 (June 28-July 5, 2024)

Week 13 (July 5-July 12, 2024)

Week 14 (July 12-July 19, 2024)

Other (volunteering outside of the regular field season)

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Emergency Contact Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Family Doctor's Phone Number *

(###)

###

####

What was the date of your most recent tetanus shot/booster?

(Must be within the last 10 years to be valid)

MM

DD

YYYY

Physical Fitness: Hiking *

Please select one of the following to describe your fitness level for hiking

I have difficulty walking 1 km

I can walk 1-2 km, but have difficulty walking 5 km

I can easily walk 5 km on flat ground, but have difficulty walking 5 km on a steep mountain trail

I regularly participate in strenuous physical activity (running, hiking, biking, etc.)

I am an Olympic athlete

Physical Fitness: Climbing *

Please select one of the following to describe your physical fitness when climbing

It is difficult for me to walk up or down stairs

I can walk up or down stairs easily

I can take the stairs two at a time

I can climb up a 10 foot ladder

I am a rock climber

Physical Fitness: Balance *

Please select one of the following to describe your physical fitness when balancing

I use a cane for balance, otherwise I do not walk far

I need hiking poles on hiking trails

I am comfortable walking on uneven surfaces such as a gravel beach

I am comfortable walking on a muddy, slippery, sloped trail

I am comfortable walking on sharp, rocky shorelines interspersed with slippery seaweed

I am comfortable walking across a fallen log that is: *

30 cm/ 1 ft from the ground

60 cm/ 2 ft from the ground

90 cm/ 3 ft from the ground

120 cm/ 4 ft from the ground

150 cm/ 5 ft from the ground

I am comfortable walking under a fallen log that is: *

180 cm/ 6 ft above the ground

150 cm/ 5 ft above the ground

120 cm/ 4 ft above the ground

90 cm/ 3 ft above the ground

60 cm/ 2 ft above the ground

Liability Release Statement *

In consideration of the Laskeek Bay Conservation Society accepting my offer to assist the Society as a volunteer on East Limestone Island and understanding that my volunteer activities will take place in a wilderness environment with all its attendant in dangers. I HEARBY AGREE to release the Laskeek Bay Conservation Society and its members, contractors, and volunteers, both as part of the Society and as individuals, from any and all liability, actions, claims or demands arising out of any loss or injury I may suffer while participating in the projects of the Laskeek Bay Conservation Society, or out of any damage that may occur, whether by gross negligence or any other cause, act or mission on the part of any member of the Laskeek Bay Conservation Society.

I HEREBY AGREE to be bound by the terms of this release which I have read and understood.

Emergency Insurance Statement *

If you need to leave the field early for any reason, you will be responsible for the full cost of transport. In the event that you are injured or require medical attention and the LBCS medical attendant feels that you should leave the field, he or she will arrange an evacuation. You will need to carry insurance to cover medical evacuation costs. Please check with your insurer and sign the following statement: I UNDERSTAND that I will be in a remote location and should a medical emergency occur, I may be air evacuated. I AGREE to have appropriate medical coverage as I will be responsible for all costs of the air evacuation. If I must exit the field early for any reason, I will be responsible for the full cost of this transportation. I understand that the Laskeek Bay Conservation Society has neither funds nor responsibility to cover an evacuation.

I agree.

Photo Release Statement *

In order that we may have current photos to use on our website, promotional materials and information presentations Laskeek Bay staff may take photos in which you are included. This agreement states that you agree to the use of such photos in LBCS materials. I HEARBY AGREE to release any photos A) taken by the Laskeek Bay Conservation Society and its members OR B) that I have taken and given to the Laskeek Bay Conservation Society, to be used in promotional, educational and information materials produced by the Laskeek Bay Conservation Society

I agree.

Date *

MM

DD

YYYY