Christ Covenant Church
Disaster Response Survey
Christ Covenant Church member
Disaster response interest and skills
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Democratic Republic of the Congo
Republic of the Congo
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Curacao
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Home Phone
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Work Phone
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Email
Phone Number
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How much lead-time would you need to get ready to participate in a project?
Interest/Experience
Would you be interested in assisting with a disaster relief project by our church?
(Check all that apply)
In this community?
In Mecklenburg County?
Within the Presbytery?
In North Carolina?
In the United States?
Internationally?
Check the disaster ministries
that INTEREST you:
Advisory/advocacy
Bulk distribution
Caring for pets
Casework
Chainsaw crew/tree removal
Child care
Cleanup crew/debris removal
Clerical assistant
Communications (including ham radios)
Computers
Counseling
Damage assessment
Driver
Elderly care
Employment assistance
Evacuation of persons
General handyman
Housing coordinator
Interpreter/translator (include info below)
Legal aid
Meal preparation
Medical emergency team
Prayer team coordinator
Procurement
Reconstruction team
Repair (emergency)
Resources/logistics
Safety
Salvage
Sanitation
Security
Shelter management/care
Site manager
Special needs care
Transportation
Other (include info below)
Check the areas where you
are EXPERIENCED:
Advisory/advocacy
Bulk distribution
Caring for pets
Casework
Chainsaw crew/tree removal
Child care
Cleanup crew/debris removal
Clerical assistant
Communications (including ham radios)
Computers
Counseling
Damage assessment
Driver
Elderly care
Employment assistance
Evacuation of persons
General handyman
Housing coordinator
Interpreter/translator (include info below)
Legal aid
Meal preparation
Medical emergency team
Prayer team coordinator
Procurement
Reconstruction team
Repair (emergency)
Resources/logistics
Safety
Salvage
Sanitation
Security
Shelter management/care
Site manager
Special needs care
Transportation
Other (include info below)
Additional Interest, Experience, or Comments:
Training
Check if you have SPECIALIZED TRAINING in the following (please add comments below):
Advanced first aid and CPR
Bricklayer
Carpentry
Chaplain
Crisis counseling
Disaster relief
Dry walling/painter
Electrician
Emergency child care
Evangelism
General contractor
Heavy equipment operator
Mass feeding
Nurse
Paramedic
Physician
Plumbing
Roofer
Safety
Additional Training or Comments:
Do Not Fill This Out