Disaster Response Volunteer Sign Up Form

If you would like to be listed as a potential volunteer or have equipment that the Disaster Response Team could use, please consider signing up. By signing up, you are simply listing yourself and/or equipment in an internal database. The Core Team will contact individuals before committing them or their equipment to any responsibilities.

Name

Cell Phone

Home Phone

Address

I am interested in assisting with a disaster response project by our church:

Please select all that apply.

In this community In this county In this state In the USA Internationally

How much lead time would you need to get ready to participate in a project?

Interest, experience, and training (check the types of disaster ministries that interest you.)

Please select all that apply.

Chainsaw crew or tree removal Communications (ham radio) Elder care (or handicapped) Food service Interpreter Medical emergency Transportation Child care Cleanup crew Counseling Damage assessment Employment assistance Evacuation of persons Goods distribution Legal aid Reconstruction

Do you have any disaster response training

Please select all that apply.

Mission to North America disaster training State disaster relief training Previous disaster response Red Cross Other

Equipment available for use

Please select all that apply.

Air compressor Generator Oxygen tank Sanitation equipment Chainsaw High volume pump Portable stove Submersible pump Other

Vehicles

Please select all that apply.

4x4 ATV Bus Tractor-trailer Truck Aircraft Boat Camper Trailer Van

Tools and supplies

Please select all that apply.

Wheelchair Cots Electric Cords Garden hose Mop Shop vacuum Broom Crutches First-Aid kit Hand tools Power tools Shovels

Disaster Response Volunteer Sign Up Form

Description

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