Animals' Disaster Team - Helping Your Pets When It's Needed the Most
PLEASE PRINT OUT AND SEND APPLICATION TO THE PO BOX LISTED BELOW
 
 
Animals’ Disaster Team, P.O. Box 609205, Cleveland, OH 44109
 
APPLICATION FOR MEMBERSHIP
 
 
 
DATE __________________________________
 
 
FULL NAME _________________________________________________________________
 
 
ADDRESS ___________________________________________________________________
 
 
COUNTY ____________________________________________________________________
 
 
PHONE (DAYS) _____________________________ (EVE) ___________________________
 
 
CELL PHONE ______________________________  E-MAIL __________________________
 
 
ANIMAL RELATED INTERESTS ________________________________________________
 
 
_____________________________________________________________________________
 
 
 
 
I understand that this application for membership in training with the Animals’ Disaster Team (ADT) must be approved beforeI am considered a member-in-training. I further understand that I am making a personal commitment to participate as a volunteer. I also understand that for this program, I must be 18 years of age or older for Cuyahoga, Lorain or Summit Counties and I must be 16 years of age (with parental consent) or 18 years (no consent needed) to participate in Medina County. I understand there is a Registration Fee of $10.00, which is enclosed.
 
 
I understand that I am required to complete the ADT Basic Training program before I can be certified as a member of the ADT. I further understand that I am required to complete all Continuing Education Classes offered to me, as soon as possible after my certification. I also understand that I may be required to complete and pass a recertification test every three years after my initial certification.
 
 
I fully understand and accept that there could be a certain degree of physical activity and risk involved with joining this or any disaster management program. For the safety of myself, other team members and the animals, I agree to abide by all rules and regulations established by the Animals’ Disaster Team before, during and after my training process.
 
 
                                                           
                                                                                                      ______________________________      ________________________________    
Signature of Applicant & Date                        Witness Signature & Date
 
 
______________________________________                              
Signature of ADT Staff Member & Date approved 
 
 
Registration fee enclosed _________   
 
 
ADT/Form 100-Membership Application-Rev. 2/09
 
 
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