Disaster Volunteer Resource Center

How To Enlist

Sign on in advance to help in times of disaster.  Tell us how to get in touch with you:
Name: 
Date of Birth
Address: 
City: 
State: Zip:
Phone Day: Fax: 
Phone Evening: Cell:
E-mail:

Skills / Profession/Areas of Interest
(Check appropriate categories and any special skills for category)
Note: If license/certification is required, you must provide it upon request.
 

Administration/Supervision
Animal Care
Animal Rescue
CDL
 

Bus Driver
Trucker

Child Care
Communications
 

Ham Radio/CB Radio
Cellular
Phones
Other

Computer Skills
 

Computer Operation
Computer Repair/Installation
Data Entry
Other

Construction/Repair
 

Home Repair
Welding
Other

Counseling
 

School Counselor
Clergy
Licensed Mental Health Practitioner
Psychiatrist
Psychological First-Aid
Other

Damage Assessment
Debris Removal/Clean-Up
Driving
EMT/Fire & Rescue
Farmer
Food Service
 

Food Preparation
Food Management
Other

General Office Skills
Heavy Equipment Operator
 

Fork Lift
Other

Languages
 


Spanish
(SpeakReadUnderstand)
Neur
(SpeakReadUnderstand)
Sign
Other 

Law Enforcement
Mechanical Ability
Medical/Veterinary
 

Dentist           Paramedic
Lab Tech/MTLPN
Physician      RN
NP                Veterinarian
PA                X-Ray Technician
Other

Missing Person Search
Mortuary Service
Security Experience
Shelter Services
Special Populations
Seniors
 

Disabled
Other

Teacher
Waste Disposal
Other
When Available:

Days: 

Evenings: 

Nights: 

 M   T  W Th  F  S Su

Length of time available (1 week, 1 month, open)

 
 
 

I prefer to be: Inactive (prepared for service only in an emergency or disaster)
  Active (leader, recruiter, trainer, community health initiatives, etc.)

Where Available: Boone Colfax Platte All of Nebraska
  Butler Nance Polk Other

Special Requirements: Sitter for Children
  Disabilities
  Other

Restrictions:

Date of Last Tetanus Shot:

I hereby make application to become a disaster response volunteer in the area. I also hereby give permission for this information to be shared exclusively between the Columbus Area United Way, East-Central District Health Department, Platte County Emergency Management and the Prairie Valley Chapter of the American Red Cross.
Initial for Signature:  Date: 

 

   


 

Volunteering is a reward everyone deserves enlist now to discover yours!