PCCR - Mississippi Tornado Response

PCCR - Mississippi Tornado Response

Thank you for your interest in serving with Plain Compassion Crisis Response.

Personal

First Name*

Middle Initial*

Last Name*

Street Address*

Check this box if your mailing address is different from your physical address

Mailing Address Different

Mailing Address

City*

State / Province*

Please use the two-letter abbreviation for your state (with capital letters). For example: PA

Postal / Zip Code*

Country*

Select or enter value

Age*

Phone Number*

Phone

Email*

Secondary Contact Name*

(another person to call if we need to confirm info on the application)

Secondary Contact Phone Number*

Phone

If your emergency contact person is a different person than your secondary contact person, check this box

Emergency Contact Name

Emergency Contact Phone Number

Phone

Work

Volunteers for tornado relief efforts.*

Number of volunteers I will be bringing for cleanup (including myself).

Volunteers for cleaning and cooking.*

If you have ladies or additional people who would stay at the lodging facility to help clean and cook, enter that number here. If zero, enter 0

Work Start Date*

What date will you be ready to start work? (7:00 AM start time to receive assignment)

Work End Date*

What is the last day you will be working?

Equipment You Will Be Bringing

Chainsaw*

How many chainsaws are you bringing? If zero, enter 0

Skid Loader*

How many skid loaders are you bringing? If zero, enter 0

Note: Skid loaders are 'highly recommended' to have tracks. Skid loaders with wheels 'may or may not' work on this project.

Dump Trailer*

How many dump trailers are you bringing? If zero, enter 0

Work Truck*

How many work trucks are you bringing (available to pull trailers if needed)? If zero, enter 0

Other Tools / Equipment

Small cleanup tools are needed, such as yard and garden rakes, shovels, leaf blowers, etc.

Small hand tools such as hammers, pry bars, etc for potential minor demo work would also be helpful.

Skills / Training

List any skills or trainings that you have that may be of use.

Lodging

Lodging Needed*

Will you be needing lodging? (There is no charge for lodging at this time.)

Yes

Lodging Check-In Date*

Arrive before 9:00 PM for lodging. If planning to arrive later than that, call ahead to make arrangements.

Lodging Checkout Date*

Couples*

Of the total amount of people needing lodging, how many couples are there? If zero, enter 0

Men*

Of the total amount of people needing lodging, how many are men for the men's dorm? If zero, enter 0

Women*

Of the total amount of people needing lodging, how many are women for the women's dorm? If zero, enter 0

Confirmation

Check if you do NOT want email updates.

Generally, all volunteers are added to the database to receive the PCCR email updates. If you do NOT wish to receive the email updates, please check the box below.

I am volunteering at my own risk.*

I understand that I am volunteering at my own risk. I will not hold PCCR responsible for any accidents or damage incurred to or by myself and my property or anyone on my team and their property. By checking below, I affirm that I understand and agree to all stipulations in this form, and that all information I have entered on this form is true and correct to the best of my knowledge.

All Done! Please Click Submit Below

Send me a copy of my responses

Privacy Notice|Report Abuse