BECOME A DISASTER VOLUNTEER

Disaster Volunteer Registration Form

First Name

Last Name

Email Address

Phone Number

Emergency Contact Name

Emergency Contact Phone Number

What are you interested in assisting with?

Would you be willing to volunteer at a shelter during a storm?

Yes

Maybe

Please list any physical limitations

Please list any supplies or certifications you have.

Have you ever been convicted of a felony?

Release of Liability Statement

Electronic Signature for Liability Release

Sign above