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DISASTER ANIMAL RESPONDER — VOLUNTEER REGISTRATION FORM

KINSHIP CIRCLE DISASTER ANIMAL RESPONSE TEAM (KC-DART) activates for animals in natural and human-made disasters. We work in agreement with emergency agencies and NGOs to implement an animal disaster plan, following FEMA National Incident Management System (NIMS). Please read volunteer requirements below and fill out our registration form.



TO DEPLOY AS AN DISASTER ANIMAL RESPONDER WITH KINSHIP CIRCLE, YOU AGREE TO:
1)  Complete/submit this form. You may not deploy unless registered with Kinship Circle.

2)  Follow FEMA Incident Command System as set forth by Kinship Circle and associated agencies.

3)  Be 21 years of age with a U.S. driver’s license. International driver’s license required for deployment abroad.

4)  Independently undergo disaster response training and certification.
      MINIMUM REQUIREMENT TO DEPLOY WITH KINSHIP CIRCLE:
      a) FEMA Independent Study Program
          • IS-100.b (ICS 100) Introduction to Incident Command System
          • IS-200.b (ICS 200) Single Resources and Initial Action Incidents
          • IS-700.a National Incident Management System (NIMS), Intro
          • IS-800.b National Response Framework, An Introduction

      b) Disaster Animal Response Training
          • Links to on-site training workshops nationwide

5)  Be a self-sustaining volunteer who pays for the following deployment costs — unless individually sponsored by       Kinship Circle under special, pre-negotiated circumstances.**
      • Travel expenses, including airfare and travel from airport to disaster site (i.e., train, bus, cab).
      • Lodging on the ground — only if Kinship Circle has been unable to secure an affordable volunteer base.
      • Long distance phone/communication bills.
      • Food and personal sustenance.
      • NOTE: Kinship Circle DOES cover most volunteer lodging; disaster-site vehicle rental as needed abroad; some
         international phone use via a team rental phone; situational emergency costs on ground.

**Kinship Circle is a network of independently trained volunteers that works on a collaborative basis, calling upon its disaster responders for input on the ground and remotely. While we offer a more hands-on disaster rescue experience — we are minimally funded and cannot cover most volunteer deployment costs. This must be accepted prior to any deployment.
Failure to comply with requirements on this form may result in termination as a Kinship Circle volunteer.

Answer all 10 questions below. If some do not apply to you, type N/A in the box.




1) ENTER PERSONAL CONTACT INFORMATION & SEND ID PHOTO.
Fields with asterisk * are required.

*First Name  
*Last Name  

Organization  

*Address 1  

Address 2  

*City  

*State  

*Zip Code  

*Country  

*Cell Phone  

Land Phone  

* Email  


Are You A Member Of Kinship Circle?
  • IF YOU ARE NOT SUBSCRIBED TO OUR EMAIL LIST — SUBSCRIBE NOW.
    To volunteer for Kinship Circle, you must be subscribed to our Action/Update Email List.

Send a photo of yourself for Kinship Circle to privately file with your form.
  • FOR ID AND EMERGENCY PURPOSES, EMAIL YOUR HEAD SHOT TO: info@kinshipcircle.org
    Type in subject line of email: JANE SMITH, DISASTER ID PHOTO



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:


      
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