Green Alert Mutual Aid Volunteer Intake Form

Green Alert Volunteer Form
Name

First NameLast Name
Birth Date

MonthDayYear
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Availability
Which volunteer role are you interested in? (Please select one or more)
What mile radius are you willing to travel
Additional notes about your schedule
Experience and Skills
Do you have any volunteering experience? If yes, please describe.
Please indicate if you have any of the following skills or training
Transportation (For Drivers)
Have you driven supplies for a disaster relief effort before? (Yes/No)
Do you have access to a vehicle? (Yes/No)
Are you comfortable driving in various weather conditions? (Yes/No)
Do you have car insurance (Yes/No)
Do you have a valid driver's license? (Yes/No)
Do you have any physical limitations or health concerns we should be aware of? (Yes/No) (If yes, please specify)
Is there anything else you would like us to know about you or your willingness to volunteer?
Consent and Agreement
Do you agree to adhere to all safety protocols and guidelines while volunteering? (Yes/No)
Do you consent to have your information stored for volunteer coordination purposes? (Yes/No)
Do you consent to having your photograph and/or video recorded during your volunteer activities with Democracy Green? These images may be used for promotional and outreach purposes to support the relief efforts, including but not limited to social media, newsletters, and other marketing materials. (Yes/No)
No Liability Statement

By signing below, I acknowledge that I am voluntarily participating in the volunteer activities organized by Democracy Green and its associated partners. I understand that volunteering may involve risks, including but not limited to physical injury, property damage, or other unforeseen incidents.I hereby release, waive, and discharge Democracy Green and its employees, agents, volunteers, and any affiliated organizations from any and all claims, demands, or causes of action that may arise from my participation in these activities. I agree to assume full responsibility for any risks of loss, property damage, or personal injury that may occur while I am participating as a volunteer. I further attest that I have read and understood this liability statement and agree to abide by all safety protocols and guidelines set forth by Democracy Green
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Democracy Green is a 501c3 Environmental & Climate Justice Conservation Organization that has specialized in Community Disaster Response since 2018 through mutual aid, community resiliency strategies and community outreach, operating in all phases of a disaster.

Democracy Green operates mutual aid hub installations and mobile mutual aid hubs during major storm events.

Democracy Green is seeking volunteers for the 2024 Hurricane Helene outreach. Volunteers are needed to receive and sort incoming donations, drivers to dispatch aid and on-the-ground community outreach support.

GreenNet@DemocracyGreen.net

www.Democracy-Green.org
Should be Empty:

Green Alert Volunteer Form

Availability

Experience and Skills

Transportation (For Drivers)

Consent and Agreement

No Liability Statement