Hudson Disaster Animal Response Team (Hudson DART) Volunteer Application Applicant Information Full Name: Last
First
M.I.
Address: Street Address
Apartment/Unit #
City
State
Phone:
ZIP Code
Emergency Contact Information
Emergency Contact Relationship
Full Name: Last
First
M.I.
Address: Street Address
Apartment/Unit #
City
State
Phone:
Animal Handling Experience
ZIP Code
Experience, Training and Affiliations
Do you have experience handling dogs? Do you have experience handling cats? Do you have experience handling other species? (If yes, please list under comments) Training Are you certified in FEMA’s course ICS 100.C, “Introduction to the Incident Command System”? Are you certified in FEMA’s course IS 700.B, “Introduction to the National Incident Management System”? Affiliations Are you a member of the State of Massachusetts Animal Response Team (SMART)? Are you a member of the Medical Reserve Corp?
Comments
YES
NO
YES
NO
YES
NO
YES
NO
If yes, date of completion? Record attached?
YES
NO
If yes, date of completion? Record attached?
YES
NO
YES
NO
If yes, date of SMART membership If yes, date of MRC membership If yes, town of MRC membership
Preferred Volunteer Duties Paperwork? Pet Owner Interaction? Animal Care? Assembling/Lifting Cages? Technical Work?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Signature Signature:
Date: