Picfair Village Disaster Emergency Preparedness Team (DEPT) - Registration
First and Last Name
Street # (just the number)
For example, if you live or work at 1654 Spaulding, enter only '1654' in the line below
S. Orange Grove
S. Sierra Bonita
Cell Phone #
Home Phone # (if applicable)
Best way(s) to reach you during non-disaster times (for planning purposes)
Keep in mind that during a disaster/emergency, we may not have a choice!
When are you usually in the neighborhood?
Evenings and Weekends (I live in Picfair Village but work in another part of the city)
Business Hours During the Work Week (I work in Picfair Village but live in another part of the city)
All of the time (I both live and work in Picfair Village or the surrounding areas)
Preferred Role(s) with the Picfair Village Disaster Emergency Preparedness Team:
Please select only the role or roles you are qualified to fill.
Trained/Certified for Medical Assistance
***Relevant Training, Skills and Experience***
Please include any additional information below
Are you trained in any of the following?
Certified First Aid
Are you are Certified Medical Professional?
If you are, please describe what you do below.
Do you have any other skills, experience or items that might be helpful in a disaster, or in planning for one, such as:
Police Officer/Law Enforcement
Veterinarian/experience working with animals
Large-scale search and rescue experience
Large-scale clean up experience
Own a truck or off-road vehicle
Own construction equipment
Own a satellite phone
If you have any questions about this effort, please type them below.
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