Community Service Volunteer Signup

Disaster Relief Information

Would you like to volunteer in the event of an emergency?*

Yes No

What phone number (including area code) can we reach you at quickly in the event of a disaster?*

Please check your skills related to disaster relief:

Account/Financial Planners

Administrative Support

Amateur Radio Operator

Animal Handler (SMART)

Bus Driver

Carpentry

Child Care Provider

Civil Engineering

Cleaning Services

Communications Systems Repair

Computer Technician

Construction Operator

Cook/Food Service Worker

Crisis Counseling

Data Entry

Database Administrator

Debris Hauling

Doctor

Elder Care Provider

Electrician

EMT

Fire Fighting

First Aid/CPR Certified

Fork Lift Operations

Heavy Equipment Operations

Heavy Lifting/Rigger

HVAC Repair

Hydraulics

Insurance Adjuster/Consultant

Infrastructure Repair (Bridges, Roads, etc)

Laborer

Lawyer

Network Administrator

Nurse

Paving

Plumber

Relocation services

Roofer

Security services

Social/Case Management services

Tree Removal

Truck Drivers

Describe any equipment you could and would bring to assist in the event of a disaster

Do you speak any of the following languages fluently?

Spanish

Portugese

French

Polish

Italian

German

Greek

Russian

Arabic

Cantonese

Japanese

Sign Language

If travel to site necessary, how many hours will you need to prepare for travel*

            Less than 1 Hour
            Between 1 and 3 Hours
            Greater than 3 Hours

Are you able to pay your own travel expenses?*

Yes No

Personal Information

E-Mail:*

Valid e-mail is required

First Name:*

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Marital Status:

Gender:

Date of Birth:

Phone:*

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