Emergency Volunteer Registration

3288 Post Road
Warwick, RI 02886
(401) 732-1100
FAX: (401) 732-1107
Email Us

Emergency Volunteers

Application

If you would like to be considered to serve as a volunteer before, during or after an emergency situation please complete the form below. Interviews will be scheduled with applicants being considered.

First Name		Last Name
Are you over 18 years of age?		yes no
Company Name
Profession
Phone
Fax
Cell Phone
Pager
Email
Address
City/Town		Zip Code
Next of Kin1		Phone1
Next of Kin2		Phone2
Do you have any medical problems?		yes no
If yes, please explain
Do you have any allergies?		yes no
If yes, please list
Do you have any restrictions?		yes no
If yes, please list

Do you have your own transportation?		yes no
Do you have volunteered previously?		yes no
If yes, what role did you play?
Do you own a 4wheel drive vehicle?		yes no
Make
Model
Year
How many people does it fit (in addition to you)
Do you own a CB radio?		yes no
Do you own a Marine radio?		yes no
Are you certified in CPR?		yes no
Are you certified in First Aid?		yes no
Are you certified as an EMT?		yes no
Red Cross Training will be provided for individuals selected.
Are you available during an event... check all that apply
7:00 a.m. - 3:00 p.m.
3:00 p.m. - 11:00 p.m.
11:00 p.m. - 7:00 a.m.
Are you available prior to an event to assist with the setup?		yes no
Are you available after the event to assist with the cleanup?		yes no
Will someone else be coming with you?		yes no
1st person - Name		Age - if under 18
2nd person - Name		Age - if under 18
3rd person - Name		Age - if under 18
Do we have your permission to perform a BCI check? (background criminal investigation)		yes no
Position Preference 1
Position Preference 2
Position Preference 3
Training will be provided for individuals selected.