ANIMALS’ DISASTER TEAM
APLICATION FOR MEMBERSHIP
DATE________________________________________________
FULL NAME__________________________________________________
ADDRESS____________________________________________________
COUNTY_____________________________________________________
PHONE (DAYS)________________________(EVE)__________________
E-MAIL______________________________________________________
ANIMAL RELATED INTERESTS __________________________________________________________________________________________________________________________
I understand that this application for membership in training with the Animals’ Disaster Team (ADT) must be approved before I am considered a member in training. I also understand that for this program, I must be 18 years of age or older for Cuyahoga or Lorain County and/or I must be 16 years of age to participate in Medina County.
I understand that I am required to complete the ADT Basic Training program before I can be certified as a member of the ADT. I further understand that I am required to complete all Continuing Education Classes offered to me before my first anniversary as a certified member. I also understand that I will be required to complete and pass a recertification test every three years after my initial certification.
For the safety of other team members, the animals, and myself I agree to abide by all rules and regulations established by the Animals’ Disaster Team before, during and after my training process.
Signature of Applicant & Date ______________________________________
Signature of ADT Staff Member & Date _____________________________________
ADT County Affiliation ________________________________________
(which county/counties would you like to serve)
ANIMALS’ DISASTER TEAM
VOLUNTEER RELEASE FORM
I ____________________________________________, Understand that the position I am accepting with the Animals’ Disaster Team is on a volunteer bases and that I will receive no compensation for my services.
I understand that all efforts have been made to protect me as a volunteer during the required training sessions necessary for certification as a member of the Animals’ Disaster Team. If applying in Cuyahoga or Lorain County, I acknowledge that I am over the age of eighteen years.
I further understand that as an emergency responder, there is an undetermined amount of risk involved, and I accept that responsibility. I agree that in the event I am injured during any critical incident I am responding to, I release the Animals’ Disaster Team, and all Chapters of the ADT, of any and all liability.
I agree to respond to the best of my ability and to abide by the rules and regulations of the Animals’ Disaster Team.
Date_____________________Signature ______________________________
Date_____________________Signature of Witness ______________________________
Please mail this completed form to:
ADT