Kinship Circle Volunteer Form

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DISASTER RESPONSE VOLUNTEER FORM

KINSHIP CIRCLE ANIMAL DISASTER AID NETWORK is a nonprofit that mobilizes resources for animal victims through its network of trained responders in the U.S. and Canada. We work in agreement with government agencies or NGOs to deploy trained and credentialed animal responders for assessment, search and rescue, and emergency sheltering aid. We also report disaster news, to inform the public about ways they can support animal relief efforts.

You are responsible for training and certification in disaster response. You are self-sustaining, including transportation. You are expected to follow the command structure set forth. Failure to do so results in termination as a Kinship Circle volunteer.

ANSWER ALL 10 QUESTIONS BELOW. IF SOME DO NOT APPLY, TYPE N/A.

1) ENTER CONTACT INFORMATION AND ANSWER ALL APPLICABLE QUESTIONS. Fields with asterisk * are required.

*First Name

*Last Name

Organization

*Address 1

Address 2

*City

*State

*Zip Code

*Cell Phone

Land Phone

* Email

**ARE YOU SUBSCRIBED TO KINSHIP CIRCLE'S EMAIL LIST TO GET DISASTER UPDATES? Yes No

2) FEMA CERTIFICATIONS:

List each FEMA course number and title you have completed.

3) DISASTER TRAINING CERTIFICATIONS:

List course title, agency, year of training.

FOR EXAMPLE: CERT, SART, CART, Red Cross & First Aid Trainings; Fire, Water, SAR, TAR, etc.

4) ANIMAL DISASTER COURSES AND CERTIFICATION:

List training organization, year of training.

FOR EXAMPLE: UAN/EARS; HSUS/NDART; Noah's Wish; American Humane; MuttShack Rescue, etc.

5) RELEVANT PROFESSIONAL EXPERIENCE:

FOR EXAMPLE: Veterinarian, Vet Tech, Animal Control Officer, Shelter Worker, Paramedic, Fireman, Nurse, etc.

6) ANIMAL DISASTER AID EXPERIENCE:

List name/year of disaster. List organization you deployed under and your duties.

FOR EXAMPLE: Hurricane Katrina, 2005. ARNO, food/water stations and transports…etc.

7) PHOTOGRAPHY AND DOCUMENTATION SKILLS:

List amateur or professional experience you have in photography, videography and documentation.

Describe the type/model camera you can bring on deployments.

8) MORE SPECIALIZED SKILLS:

List additional skills helpful in disasters. FOR EXAMPLE: Can you bring a laptop and compile daily field notes?

9) TRANSPORATION / SELF SUFFICIENCY:

VEHICLE: Tell us the type vehicle you can drive to and within the disaster zone.

Do you have: Tent, Sleeping Bag, Food, Petty Cash?

10) CURRENT VACCINATIONS:

Which vaccinations are you current in? Copy/paste each that applies into the box below:

Tetanus, MMR, Polio, Hep A, Hep B, Typhoid, Rabies, H1N1, Flu

Please enter the code to the left exactly as you see it in the space below. The code is case sensitive. Confirmation code:

SUBSCRIBE TO OUR EMAIL LIST. You must subscribe to our email list to get updates during disasters.

Kinship Circle Animal Disaster Aid is a nonprofit that mobilizes resources for animal victims through its network of trained responders in the U.S. and Canada. We work in agreement with government agencies or NGOs to deploy highly trained and credentialed animal responders for assessment, search and rescue, and emergency sheltering aid. We also report disaster news, to inform the public about ways they can support animal relief efforts.

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Kinship Circle
7380 Kingsbury Blvd.
St. Louis, MO 63130