Volunteer Application Form

Submission by internet may or may not be received due to the nature of the web.

Please print this form and bring to an open general membership meeting

Please complete the form below and then print!

Applications must be complete, correct and signed to be considered!

Commonwealth Search & Rescue does not determine subscriber eligibility based on sex, race, creed, persuasion 
and or religion. All applicants must be a minimum of sixteen (16) years old, have received no 
dishonorable discharges from military service and must not be convicted of any Schedule 1 offence.

Please Identify and Describe Yourself:

Date of Birth
Sex	Male    Female
Height
Weight
Hair Color	Blonde Brown Black Red Gray White
Eye Color	Blue Brown Black Green Gray Violet
Employer
Occupation

Next of Kin / Emergency Contact :

MEDICAL HISTORY: Please explain any "Yes" response.  This information will remain highly confidential. How would you describe your current health? Blood Group:    How would you describe your current physical condition? Do you now have or have you had any serious medical condition?    Yes     No Have you been hospitalized in the past year?         Yes     No Do you have any other medical or health condition which might adversely affect you in the field?         Yes     No      If Yes, please select one of the following options that may apply: Physical Visual Are you Colour Blind?    Yes     No List any allergies or medications you are currently taking:   EXPERIENCE AND TRAINING: Check any areas in which you have had any Experience and or Training: 4x4 Driving Operation Flying (as a pilot) Search and Rescue Abseiling Incident Command Search Dogs Backpacking/Hiking Interview Skills Search Fundamentals Caving Land Navigation/Compass Search Management Cave Rescue Law Enforcement Survival Map Reading Swift Water Rescue Communications Public Information/Relations Tracking Disaster Response Rope Rescue, Basic Other (please specify Firefighting Rope Rescue, Hi-Angle below) MEDICAL TRAINING BACKGROUND: Please identify your current medical certification level, training, or experience (if any). CERTIFICATION TYPE / LEVEL CERT. NO. EXPIRY DATE  (dd/mm/yy) FIRST AID CPR   EMT PARAMEDIC MD, RN  Please describe your experience in Medical Services: Any Other Categories:

Other: RESPONSE INFORMATION: Would you be able to respond to a call in the middle of the night?      Yes     No Would you be able to respond to a call overnight in bad weather? Yes     No Does your spouse and family understand the conditions of this application? Yes     No Do you understand that calls may come at various times of day or night? Yes     No   Do you understand that if at all possible you would be expected to respond to callouts (Barring family and work emergencies) ? Yes     No Do you understand that, once accepted as a subscriber, you will be expected to attend training and exercises on a regular basis? Yes     No Do you have any other emergency-response commitments that might create a conflict? Yes     No If Yes, Please explain: Which position are you applying for? (You may select more than one) 4x4 Operative (Transport / Logistics / Communications) Base Ops (Communications / Incident Planning / Incident Management / Mapping) General Search and Rescue (Search Management / Admin / Communications) Field Operative (Mountain Skills / Communications / Rope Rescue)   I, ___________________________________ , am aware that while a subscriber to Commonwealth Search & Rescue, (also known as CSAR), I may be participating in and responding to activities that are inherently dangerous, including, but not limited to, the hazards of traveling in wilderness terrain, accidents or illness, the forces of nature and travel by automobile, aircraft or other conveyance. I understand that, except when otherwise provided, insurance, workman's compensation, and liability coverage is not provided and that I am solely responsible for any injury, illness, or other medical care required by myself while participating as a member on Commonwealth Search & Rescue activities. I agree to maintain the minimum insurance required by law in my home state, on my  personal vehicle if I choose to drive it on Commonwealth Search & Rescue activities and that I will be responsible  for any and all damage to my vehicle and other property while on Commonwealth Search & Rescue activities. I do these things entirely on my own initiative, risk, and responsibility, and assert that I will do nothing that is beyond my training and expertise.   In consideration of the benefits to be derived, I do hereby for myself, my heirs, executors, and administrators, release and forever discharge Commonwealth Search & Rescue, its directors, subscribers, officers, and agents, from any and all claims, demands, actions, or causes of action, on account of my death or injury, or for damage to my personal property, as a result of my participation in Commonwealth Search & Rescue activities.  I understand that if I do not feel comfortable or competent in a given situation, it is solely my  responsibility to ensure that I stop the activity immediately and in a safe manner.  I hereby agree to  abide by all rules, regulations, policies, and procedures prescribed for in the subscription to Commonwealth Search & Rescue and I understand that I may be terminated from said membership for any cause, at any time, upon written notice to myself, mailed to me at the address given on this application for subscription.  I understand that I may voluntarily terminate my subscription to Commonwealth Search & Rescue at any time upon written notice mailed to the organization's usual mailing address, or delivered to any director of the organization, by any means.  I understand that, in order to maintain an active subscription, I must keep Commonwealth Search & Rescue appraised of any changes in name, mailing address, or telephone number, etc.  I desire to become an active member of Commonwealth Search & Rescue. I agree to attend the required  number of training lectures / classes to establish and maintain my ability as a competent member of  this organization and to acquaint myself with the duties and other members of Commonwealth Search & Rescue. I have read and understand the requirements of this application to become a subscriber to this  organization, and promise to abide by and adhere to the Procedures, by-laws and all operational rules  and regulations as set forth by Commonwealth Search & Rescue to the best of my ability.  Additionally, I attest that all the information provided by me on this application is true and correct to the best of my knowledge, acknowledging that providing false or fictitious information may result in my immediate dismissal from the organization upon discovery of such. I UNDERSTAND AND FULLY AGREE TO THE ABOVE:   First Name   Last Name   Date       Until further notice, Please print this form and bring it with you to the general membership meeting Filling out the above form and pressing the submit key shall constitute your acceptance of the application form and have the full weight and effect of your written signature.