Harford County Maryland - Emergency Preparedness

Harford County, Maryland

Department of Community Services - Volunteer Connection

319 South Main Street . Bel Air . Maryland 21014

410.638.4444 or 410.879.2000

Emergency Preparedness Volunteer Registration Form
Harford County, Maryland

This application is for groups and individuals interested in assisting with storm recovery activities and are willing and able to assist those in need immediately after a local weather event. Emergency Preparedness activities include helping with snow removal for the elderly, disabled and our most vulnerable, providing transportation with four wheel drive vehicles, answering non-emergency citizen phone calls and assisting with debris clean-up.

* Required Fields

Name:	*
Street Address:	*
City, State, Zip:	*
Home Phone:	*
Work Phone:
Cell Phone:
Best way to contact you:
Date of Birth (MUST BE OVER 18):
Email:
Occupation:	May we contact you at work?
Other Languages spoken:
Have you volunteered before?	Yes No Describe Experience:
How did you hear about us?	* If Other:

Yes, I am willing to take training to assist with emergencies.

When might you be able to volunteer: (check all that apply)

Summer Only Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Times Preferred: (check all that apply)

Morning Afternoon Evening -- Specific Times:

Frequency:

Once Monthly Weekly More than once a week

Do you have a particular geographical area where you would like to serve?
(Volunteer Opportunities are for Harford and Cecil Counties Only)

Area: (i.e. Bel Air, Aberdeen, Edgewood, etc.)

I am willing to volunteer outside this area.

Transportation

Private Car Public Transportation
Other:

Emergency Action Volunteers:
(Harford County Residents 18 Years of Age and Older ONLY)
Answer Phone Lines at the Emergency Operations Center
Community Emergency Response Training
Crisis Response Team
Debris Removal (asap after a storm), include use of chain saws and heavy lifting
Donations Manager
Four-Wheel Driver (during a storm and soon after)
Medical Reserve Corps
Snow Plow/Shoveling (asap after a storm)
Other:
Yes, I have a commercial driver license:

Class Code
List Restrictions on License

Comments:

Upon receipt of this form, our staff will be in touch with you to review potential volunteer opportunities and assist you with placement.

Please call us if you have any questions regarding this form. We look forward to serving you.

Personal Workplace Disaster Supplies Kit