VOLUNTEER – 'First Response Disaster Relief'

How were you referred to FirstRDR?

Team Member
Facebook
Twitter
Other

Legal Name *

First

Last

Prefered name

Date of Birth (Month/Day/ Year) *

Email *

Cell Phone # *

Alt. Contact #

Street Address *

City *

State *

Zip *

Zello Handle

Please list Languages you can Speak?

English
Spanish
Other

What areas are you interested in volunteering with? * Check all that apply * (checking a team below does not commit you to a team - we will discuss team information & options with you, upon approval) *

If you are volunteering for SAR/Boots on the Ground do you have any of the following? * Check all that apply *

Do you have any of the following: (Check all that apply)

Please list any other resources, skills or previous training you may have.

Do you currently plan to volunteer with more than one team? If so what other teams do you plan to work with?

Have you previously volunteered with other Disaster Teams? If so what teams?

I understand that upon approval I may be asked to complete or sign additional volunteer forms. *

I understand that I may be asked to provide proof of credentials and/or Certifications

I understand False or misleading information may be grounds for immediate dismissal.

Criminal History:

I have NO criminal History
I had a ding dismissed or sucsessfuly completed terms for Deferred Adj.
I have a misdemeor
I have a felony

I AGREE TO AND ACCEPT THE LIABILITY WAIVER AS DETAILED BELOW *

LIABILITY WAIVER: In return for being allowed to participate in First Response Disaster Relief volunteer [FirstRDR] activities and all related activities, including any activities incidental to such participation ("Volunteer Activities") , the undersigned Volunteer (hereafter referred to using "I", "me" or "my") releases and agrees not to sue the First Response Disaster Relief organization or its officers, directors, employees, sub-contractors, sponsors, agents and affiliates ("the Organization") from all present and future claims that may be made by me, my family, estate, heirs, or assigns for property damage, personal injury, or wrongful death arising as a result of my participation in the Volunteer Activities wherever, whenever, or however the same may occur. I understand and agree that the Organization is not responsible for any injury or property damage arising out of the Volunteer Activities, even if caused by their ordinary negligence or otherwise. I understand that participation in the Volunteer Activities involves certain risks, including, but not limited to, serious injury and death. I am voluntarily participating in the Volunteer Activities with knowledge of the danger involved and I agree to accept all risks of participation. I also agree to indemnify and hold harmless the Organization for all claims arising out of my participation in the Volunteer Activities. I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state in which the Volunteer Activities take place and agree that if any portion of this Agreement is invalid, the remainder will continue to full legal force and effect. I also acknowledge that the Organization has not arranged and does not carry any insurance of any kind for my benefit or that of Volunteer trustees, heirs, executors, administrators, successors and assigns. I represent that, to my knowledge, I am in good health and suffer no physical impairment that would or should prevent my participation in Volunteer Activities. I also understand that this document is a contract which grants certain rights to and eliminates the liability of the Organization.