UVWRT New Member Online Application--V2

Welcome to the Upper Valley Wilderness Response Team's Online Application.

Once you have completed this form, click the "Submit" button at the bottom of the page.

Within a few days, our membership officer Chris Northrop will get in touch with you.
Once your application is processed, we ask that you come to a "team officer's meeting" generally scheduled for the third Tuesday of each month in Kellogg auditorium. At this meeting you'll get a chance to meet the team's leadership, as well as an opportunity to find out about what we do, when we train and our general team procedures.

We look forward to meeting you soon!

UVWRT Officers

(If you have any questions with filling out the application or creating a google-docs account mentioned below, please contact daniel.schneider.07@alum.dartmouth.org)

First Name

Last Name

Preferred Name

Date of Birth mm/dd/yyyy

Gender

Mailing Address

City

State

Zip Code

Contact Information When is the best time to contact you?

Home Phone

Cell Phone

Work Phone

Pager (If applicable)

Email Contact How regularly do you check your email?

Primary Email

Secondary Email (optional)

Gmail / Google Docs Account While not required, you will need to have a "Google Docs" account to access the "Google Documents" feature. This will enable you to keep track of your training progress as well as access the team's contact directory. (Instructions on how to create a Google Docs account are located at DOCS.GOOGLE.COM and click "GET STARTED". You can use your current email address, or you can create a new Gmail account) Please include the domain name (e.g."@gmail.com" or "@)comcast.net")

Occupation and Work Location (If a student, what year do you expect to graduate.)

Dartmouth College Affiliation Choose One

Do you own or have access to a vehicle to use to get to trainings and callouts?

If so, Make / Model / Year / Color

Carpool Info How many fellow team members could fit comfortably in your car, including gear?

Emergency Contact #1 Name // Relation // Phone // Address (Please separate each item with "//". Please do NOT start a new line or click "enter")

Emergency Contact #2 Name // Relation // Phone // Address (Please separate each item with "//". Please do NOT start a new line or click "enter")

Certification Expirations For all current certifications, please list expiration date. If you are a medical professional, where do you practice? (Please Separate each item with "//". Pleasse do NOT start a new line or click "enter".

Search and Rescue / First Responder Background Please describe any course or previous experience in SAR or other First Responder roles. (Please separate each item with "//". Please do NOT start a new line or click "enter")

Hiking / Camping Select appropriate description of your ability.

Winter Hiking / Camping Select appropriate description of your ability.

Rock Climbing Select appropriate description of your ability.

Ice Climbing Select appropriate description of your ability.

SAR Fundamentals Select appropriate description of your ability.

Compass / Navigation Skills Select appropriate description of your ability.

GPS Navigational Skills Do you feel comfortable using a GPS handheld unit? If you own a GPS, what brand / model do you own?

Technical Rescue Select appropriate description of your ability.

Field(s) of Technical Rescue (if applicable)

Backcountry Medical Experience Select appropriate description of your ability.

Other Skills Please list other skills or experience that you think could be useful to UVWRT. (Fundraising, Website Design, Ham Radio enthusiast, etc.) (Please separate each item with "//". Please do NOT start a new line or click "enter")

Are you comfortable working around Search and Rescue Dogs? Often, we work with New England K-9 Search and Rescue. (www.nek9sar.org)

Yes
No
Yes, but I am very allergic.

Have you been trained in safety issues concerning helicopters?

Personal goals for Joining UVWRT? Why have you decided to join UVWRT? What will make you get out of bed in the middle of the night to go search for someone you don't know? Why have you decided to join now?

Personal Contribution to UVWRT How do you think you will personally contribute to the success of UVWRT?

Call-out Availability Please describe your normal work schedule and how you expect to be able to respond to a call-out 24/7. Since we are only a volunteer team, we do understand that circumstances do not always permit. However, the success of the team hinges on each member consistently responding to call-outs

Vehicle Liability Waiver I understand that I alone am responsible for what happens to my vehicle while involved in UVWRT activities, and that no compensation of any sort is available for repair, legal actions, or any other reason. I also understand that UVWRT does not condone breaking any traffic laws or exceeding posted speed limits enroute to a training or call-out. Additionally, I will not use any kind of flashing lights or siren while enroute to UVWRT activities, even though I may be authorized to use them by another agency. DRIVE SAFELY. (Please Initial Below)

Driver Record Have you ever had your driver's license suspended? If so, how long ago? (Please explain the circumstances )

Medical Condition Waiver I understand that it is my responsibility to inform the team leader, incident commander or ranking UVWRT officer at *** EACH TEAM EVENT *** of any emotional, medical or physical conditions I may have that might affect my ability to perform tasks or assignments. (Please Initial Below)

Have you ever been convicted of a felony? If yes, please explain:

RISK / LIABILITY ACKNOWLEDGE MENTS You will be asked to fill-out a hardcopy of this "Liability Waiver" at your first team event. (Please state full legal name)

I hereby take full responsibility for my own actions while a member of UVWRT. I hold myself solely responsible while responding to, participating in, returning from and training for a search and rescue incident with UVWRT. Please Initial Below

I understand and accept the inherent risks involved with Search and Rescue activities (including but not limited to death, disability, loss of property, and incurred liabilities). Please Initial Below

I understand and accept that UVWRT provides absolutely no insurance coverage of any kind to its members. Please Initial Below

I understand and accept that should I be injured in the field, suboptimal medical conditions may exist. Furthermore, should I be injured, I authorize UVWRT to provide initial treatment as deemed necessary. Nor will I hold UVWRT, or any of its members, liable for any injury or property damage that may occur to my vehicle during such activities. Please Initial Below

I understand that if I volunteer my vehicle to provide transport for UVWRT activities, I am solely responsible for all accidents or damage that maye occur to my vehicle during such activities. Please Initial Below

I understand that my membership in UVWRT may be terminated at any time, should my behavior be deemed inappropriate by UVWRT officers. Please Initial Below

I acknowledge that I have read, understood, and agree to follow the procedures outlined in the UVWRT "Consitution and Bylaws," and "Standard Operating Procedurs." (Please Initial Below) These documents are available at www.uvwrt.org under "Procedures."

I agree that neither UVWRT, its officers, nor its members are accountable for any misfortune I should incur while a member of the team. Please Initial Below

My full name below and initials above state that I have read, understood and accept the conditions listed above. Please write your full legal name below.

Date dd/mm/yyyy

Your Questions/Feedback Please use this space to ask any questions you may have, give feedback on this application, or relate anything else you may want to tell the UVWRT officers. (Please do NOT list any personal medical information.)

SHARING CONTACT INFO WITHIN TEAM By initialing below, I permit UVWRT to list my contact information in a password protected document exclusively available to members of UVWRT and NEK9 Search and Rescue.