Skip to content
Swimdo
  • Facebook
  • Twitter
  • Instagram
  • YouTube
  • Take Action!
  • Home
  • About
    • Mission and Vision
    • Our Story
    • Our Team
    • Partners
    • Contact Us
  • Drowning Prevention
    • Our Curriculum
    • Who We Serve
  • Our Impact
  • Blog
  • Volunteer
Search
  • Search

Swimdo Volunteer Medical Questionaire

Volunteer Medical Questionnaire

This questionnaire will be treated in complete confidence and can either be submitted here on our website, or it can be printed and placed in a sealed envelope for handing to the volunteer coordinator on-site in person if you prefer. The information you provide will only be used in case of a medical emergency or to help us tailor the trip to accommodate any conditions mentioned.
Name
MM slash DD slash YYYY
Sex

Please list any vaccinations you have received that are applicable to traveling in Indonesia
Click the + button at right to add vaccinations to the list
Do you have any existing medical conditions?
Do you have any condition(s) which could impair your activities whilst volunteering with Swimdo and should be taken into consideration?
Do you have any allergies?
Do you take any prescribed medication?
Medications List
Medication
Condition Treated
 
Click the + button at right to add medications to the list
e.g. allergies / medical conditions / dissabilities (including psychological and behavioral health) and what medications you are taking for them

Translate Website

Get Updates

Sign up for our newsletter to stay up-to-date on news and ways to get involved.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Make a Gift

$25 covers the cost of our program for one local student.

Donate

Sign Up for Our Newsletter

Join our newsletter and we'll keep you in the loop about all of our latest news and ways to get involved.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

  • Home
  • About
  • Drowning Prevention
  • Our Impact
  • Blog
  • Volunteer
  • Take Action!

At Swimdo, we're revolutionizing drowning prevention and aquatic education in Indonesia.

Swimdo is a registered 501(c)(3) based in Keramas, Indonesia with our US headquarters in Santa Barbara, California.

Access Instructor Resources

Access Volunteer Resources

Get In Touch

We want to hear from you. Email us at info@swimdo.org.

© Copyright 2023 Swimdo | Privacy Policy

Nonprofit Website by Wired Impact

Back to Top