Pet Evacuation Team

Name

Home Phone#

Mailing Address

Work Phone#

Zip

Cell Phone#

Physical Address

Pager#

Zip

E-mail Address

In case of emergency:

Contact

Relationship

Phone#

Do you have any medical allergies?
No Yes / Type:

Are you afraid of any animals?
No Yes / Type:

Are you allergic to any animals?
No Yes / Type:

Do you have a current Tetanus vaccination?
No Yes / Type:

Are you have any medical condition(s) we should be aware of in case of an emergency?
No Yes / Explain:

Animal handling experience:
Dogs Cats Horses Cattle Sheep Goats
Pigs Llamas Birds Reptiles Wildlife Exotics

What experience do you have with pets or other areas? (ex. vet tech, bookkeeper, good with people, etc...)

Besides your time, what resources can you make available during a disaster?

During an activation of the Humane Society of Redmond and Deschutes County Pet Evacuation Team, it is critical that all volunteers abide by their Standard Operating Procedures. Compliance of these guidelines provide the structure to perform an organized and safe evacuation.

As a volunteer with the Humane Society of Redmond and Deschutes County Pet Evacuation Team I agree:

To follow the rules and procedures stated in the Humane Society of Redmond and Deschutes County Pet Evacuation Team's standard operating procedures.
To respect Humane Society of Redmond and Deschutes County Pet Evacuation Team's right to dismiss me as a volunteer should it be determined by the Evacuation Coordinator, Facilities Coordinator or government official including law officers and fire fighters.

Signature ________________________________ Date _________________

Official Use:
Received SAR Training __/__/__ By_______

Received SOP'S Training __/__/__ By_______

Received hat __/__/__ By_______

Received ID Card __/__/__ By_______

Notes: