8/27/22 Service Trip Sign Up & Emergency Contact Info
Please provide the following information for the flood relief service trip to eastern Kentucky on Saturday, August 27th. Your responses won't be shared with anyone besides Dr. Engle and Jessica Perry, App Center Department Manager. By submitting this form you are committing and signing up to go on the trip which will last approximately 7:15 am to 7 pm on Saturday August 27th. 

The Appalachian Center will provide transportation, snacks, and water. Please plan to eat breakfast ahead of time and bring your own lunch. You're also encouraged to bring your own water bottle. Please plan to take a covid test ahead of the trip and please do not join us if you are ill. It is also highly recommended that you be sure to be up to date with your tetanus shot before going on the trip. PPE will be provided by HDA, but volunteers are encouraged to bring their own masks/gloves if they would like. A waiver form will also be emailed to those who sign up for the trip. 

If for some reason you are unable to make it or need to cancel your registration, please contact Dr. Engle as soon as possible. 
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Name *
UK ID# *
Linkblue *
Cell phone number *
Email address *
Pronouns *
UK Department/Unit or Other Affiliation
Do you need any sort of accommodations? *
Dietary restrictions/preferences (please bring your own lunch) *
Do you have any allergies? Please explain *
Do you have any medical conditions we should be aware of (history of seizures, blood sugar condition, etc.?) ? Please explain & elaborate on what we should do in the event of a medical emergency *
Are you currently taking any medications we should be aware of should an emergency occur? Please explain *
Are you up to date with your tetanus shot? (It is highly recommended you be sure to be up to date before taking part in the trip).  *
Name of emergency contact *
Relationship of emergency contact (parent, friend, partner, etc.) *
Phone number of emergency contact *
Email address of emergency contact *
Do you have any other information to share/think I should know? *
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