medical volunteer form

Name *

First Name

Last Name

I am trained in the following areas:

Please check all that apply.

First Aid

CPR

AED

Nurse

EMT

PA/NP

Physician

I am currently certified in:

Please check all that apply.

CPR

AED

Would you be willing to attend a brief one-time informational meeting to review church emergency response protocols?

(Not required in order to volunteer)

Yes

No