Interested in volunteering to assist your neighborhood during a disaster?
We are currently accepting volunteer applications. Meetings and classes to begin shortly. Please print and complete application and mail to:
Old Mill Community
Emergency Response Team
ATTEN: RECRUITMENT
5620 Dollar Hide South Drive
Indianapolis, IN. 46221
Emergency Response Team Member
Name:
_______________________________________
Address:
_______________________________________
_______________________________________
Home Phone:
_______________________________________
Work Phone:
_______________________________________
Cell Phone:
_______________________________________
Pager:
_______________________________________
Date of Birth:
_______________________________________
Drivers License #:
_______________________________________
State Issued:
_______________________________________
List any criminal convictions in the past ten (10) years:
_______________________________________
_______________________________________
_______________________________________
Vehicle 1)
Make:
_______________________________________
Model:
_______________________________________
License Plate:
_______________________________________
Vehicle 2)
Make:
_______________________________________
Model:
_______________________________________
License Plate:
_______________________________________
I hereby authorize the officers of the Old Mill Park Community Emergency Response Team to conduct any necessary investigation, or interview with any law enforcement agency, or sheriff's office, for the sole purpose of approving my membership into the Old Mill Park Community Emergency Response Team. I hereby declare all information included in this application to be true to the best of my ability.
Prospective Members Signature:
_______________________________________
Prospective Members Name (PRINTED)
_______________________________________