ERTSAR Membership Private Application Form and Waiver

PLEASE COMPLETE THIS NEW 2021 FORM.

WE NEED THIS FOR YOUR ID CARD, T-SHIRT & DOGTAGS

All Member Application Form, Medical Declaration and Liability Release.

MEMBERSHIP

I wish to be a member of the Emergency Response Team Search and Rescue (ERTSAR). I understand that ERT SAR has high membership standards and I will endeavour to review these and maintain them.

CRIMINAL DECLARATION

I declare that I am not currently on charge for a criminal offence and do not have any unspent convictions against me which would prevent me from joining.

I submit to a vulnerable sector background (DBS UK) / Criminal Record check and can provide 2 written references.

LIABILITY RELEASE
I hereby acknowledge that I am aware of the risks to which I may be exposed during training and operations in SAR and Disaster activities, with potential minor and major accidents that may cause me or other person’s bodily harm and/or illness.

SAFETY TO MYSELF, SOPS & PPE

I fully understand and accept that The Emergency Response Team – Search and Rescue (ERT SAR), as well as connected agencies; the course coordinator, instructors and assistant personnel, have taken every precaution possible to prevent accidents, injuries and illness during these activities and it is important that I participate in this as a constructive participant (i.e., wearing PPE, following SOPS / Safety standards, not freelancing in a dangerous manner, etc.) I agree to comply with safety standards and will ensure my own safety and the safety of all others to the best of my ability.

SAFETY TO OTHERS

I will not recklessly endanger myself or other participants and in the event of any accident that may cause me bodily injury or illness during, I do release The Emergency Response Team – Search & Rescue as well as course providers, activities partners, (i.e., Advanced Rescue by DIMERSAR), coordinator, instructors, assistant personnel, from all legal liability thereof.

MEDICAL CONDITIONS & DECLARATION

I am aware this is performed in varied terrain, often in extra heat or cold environments, remote areas and may be very tiring and strenuous. I will not perform solitary tasks that would be better with aid or assistance. I understand and am aware of the Fitness and Medical requirements and will not overextend myself and declare medical issues.

FITNESS DECLARATION

I understand operational members need a good basic level of fitness and this may be tested regularly. I am fit enough to perform the fitness tests, active tasks pertaining to the expected requirements of the course including the carriage and use of equipment and will not hold ERTSAR et al responsible. I will advise if I feel unfit or unwell and not leave without informing a person in authority that I intend to do so. I also acknowledge I will inform ERTSAR of any fitness or medical / mobility issues I may have.

AGREEMENT TO RECEIVE ELECTRONIC & OTHER COMMUNICATION
We may send you information by mail, electronic or other means. We would like your agreement to do so. We emphasize this is necessary and we do NOT share your contact details and this will cease if you leave. Please maintain your up to date contact details with us.

MEDIA USE & RELEASE
From from time to time, the sessions are filmed, recorded, photographed and I acknowledge and agree to said filming, taping etc. and allow my image / recording to be included freely in websites, documents, manuals, etc.

PLEASE REMEMBER TO UPLOAD YOUR PROOF OF ID AND HEADSHOT PHOTO

(The photo should be of you recently as per Uniform Standards in a Passport style format.)

Signee Information

First Name *

Last Name *

Your Date of Birth *

Phone *

Email Address *

Confirm Email Address *

---------- || ADDRESS

Please give us your full address where we can write to you if necessary.

Your Postal Address *

Please provide number / name and street

Address Line 2

Optional Second Line (i.e., Unit, Apartment or Flat Number)

Town / City*

Please write your Town / City

County or Province*

County / Province

Postal Code *

Please write your Post Code (Zip Code for US)

COUNTRY*

Address Country

---------- || MEMBER DETAILS & QUALS

This space is for you to add some personal information on your training, skills, background and experience.

MEMBER LOCATION*

Please state which team you are generally assigned to are closest to respond to.

MEDICAL LEVEL*

Which best describes your current level of Medical Training

USEFUL TRAIING & QUALIFICATIONS*

Please take a moment to write some information on yourself, your background and training which will help promote yourself.

---------- || EMPLOYMENT ACTIVITIES

Please let us know what you do for a living.

EMPLOYMENT / DAILY ACTIVITIES*

Please put your role or anything you you do professionally for work or a routine basis. (Examples; Paramedic, Police Officer, Managing Director, Business Owner - Plumber, Full Time Homemaker, etc.)

EMPLOYER*

Please put your Employer or who you work for or the industry.

---------- || UNIFORM SIZING

We would like general information here if you wish. We can get this information later but T-Shirt size (S,M,L, etc) is useful.

SHIRT SIZE / JACKET SIZE*

Please put any uniform sizes you wish here especially T-Shirt size / Jacket Size. (Useful if we assign or you order uniform hi-Viz Jackets, Dry suits, T-shirts, etc.) Add more if you wish on file (.e., Shoe / Boot, useful if you wear our Marine Boots etc.) .

OTHER SIZES (Optional)

Please put any other sizes you wish here. Height, show / boot size, trouser waist and inseam, etc.sh on file (.e., Shoe / Boot, useful if you wear our Marine Boots etc.) .

---------- || DOG TAG INFO (Optional)

This is not for everyone. This is optional information IF you know these details please add them for your file, DogTags, etc.

MEDICAL CONDITIONS

Please list any chronic injuries you are managing, or Medical Conditions? e.g. Asthma. (If NONE, state "None.")

ALLERGIES

Please list any allergies or drugs allergies? e.g. Peanut Butter or Penicillin If none state "None."

BLOOD TYPE

Please write your Blood Type (If you know it) with Rhesus factor i.e., O Negative, A Positive / + etc. If you do not know it state N/A or not known.

RELIGION / FAITH*

Please write your faith or religious beliefs for your files / dogtags. If you wish to not comment write None or N/A

BADGE NUMBER

Please choose 4 Digits you remember well (for your badge). (0)001 to 0012 is taken and we add more digits to make your full number.

---------- || OPTIONAL MARINE / WATER ACTIVITIES

This is an optional section and information IF you wish to participate in water activities. This is not required for everyone

WATER ACTIVITIES (Optional)*

(ONLY CHECK THIS IF TRUE) If there is a water related activity or with the Marine Unit, I give my assurance to a good basic swimming ability (attest I can swim 100 yards in any stroke without a PFD and tread water for 10 minutes) and have a good basic fitness.

ANY WATER ACTIVITIES (Optional)

If there are any water based activities or qualifications you have, please mention here. For example, RYA Powerboat II Operator, PCOC Boat License, Swiftwater Rescue Technician, Swimming Certificates, etc. etc.

---------- || ATTACHMENTS / UPLOADS

Please add photo headshot and your ID verification.

ATTACHMENT UPLOADS

Please add your photos and proof of ID 1. HEADSHOT There headshot should be a clear recent photo of you, front facing (not side) and head and shoulders. No sunglasses and no hat please. (Think like a smart passport photo style.) 2. ID VERIFICATION Please upload a clear photo of your driver's license for Proof of ID. It should clearly show your name as we know it (and if the name is different an explanation why.) Finally, if you have a Criminal Records / Background check, please feel free to email that to us too.

ADDITIONAL COMMENTS & PRIVACY*

Please feel free to add anything here about your training, experience, interest or comments here. Also be advised that we will assume you agree to being on our contact list for obvious reasons, as well as for us to maintain certain record management. Be advised that you can withdraw this permission at any time especially if you should no longer be a member. Thank you

Join our member list

Attachments

Your Passport style headshot Photo *

We need a headshot for your form and possible training and ID cards. (Passport style photos are best. No one else in the photo. Photos taken now on your phone can be used. Clean background please.)

Proof of ID *

We need to verify the identification of those attending. A drivers license or passport is acceptable.

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.