PC(USA) - Presbyterian Disaster Assistance

Disaster Response Registration Form

Although the volunteer opportunities allow you to make your own contacts, we sure want to know of your talents and availabilities. We encourage you to gather a team and consider naming a team leader, who will be in contact with Presbyterian Disaster Assistance. At this time, PDA does not have the capacity for scheduling individuals into volunteer placements.

Please register your team to be part of our growing data base. Registration will enable us to notify you of new opportunities.


	Contact Name:

	Contact Address:

	City:

	State:

	Zip:

	Phone:

	Email:

	Type of Disaster:

	Sponsoring Church/ your position

	How did you find out about volunteer opportunity?

	Have you planned a work trip before?		Yes No

	If yes, when?

	Dates Available

	Start:

	For how long?

	Number of Adults:

	Number of Youth:

	Skill Level

	Basic (cleaning only) Intermediate (basic carpentry, electrical, plumbing) Expert (Licensed)

	Type of work you would like to do:

	Some sites may require that you bring certain tools or equipment with your team.

	Can you bring your own rebuilding supplies?		Yes No

	Other notes:

	This form will be forwarded to the Mission Service Team Coordinator who will be in contact with you.