Community Emergency Response Volunteer Application

Region 6, MDA - (Mass Dispensing Area)  
COMMUNITY EMERGENCY RESPONSE VOLUNTEERS (CERV) Learn Our Town's Plan And Where You Might Fit In Helping hands are needed in all areas [i.e. traffic control, floaters (escorts), phone personnel, food service, forms (handing, approving, assist in completing) clinic supply management, data processing, safety, etc]. Medical volunteers are needed also and people to assist them. 

Community Emergency Response Volunteer Application Please fill in the form on the computer and submit. Information will go to Bethel Health Department to be entered into the Local Health Alert Network database. This database is used to send out Health Alerts, Health Advisories and/or Health Updates of public health incidents and/or situations occurring in the community.

  * = required field

*Name: 
*Home Address: 
*City: 
*State: 
*Zip: 
*Home Phone: 
Home Fax #: 
*Home Email: 
Work Name: 
Work Address: 
City: 
State: 
Zip: 
Work Phone: 
Work Fax #: 
Work Email: 
Occupation/Skills:   
Cell Phone #: 

Text Messaging:  Yes No

Check any area you would be able to help us:  Customer Service Food Service Scheduling

Public Speaking Planning Secretarial

Management Foreign Language Finance

Technical Background Communication Computers

Supply Management Audio Visual Special Needs/Elderly Care

Data Input Security

 

Other: