Acadian Search and Rescue

PO Box 211

Kaplan, La. 70548

337-458-1738

Member Application Form

Mr. First Name: Last Name: Weight: Height: Hair: Eyes:

Street Address: City / State / Zip: County:

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Mailing Address: City / State / Zip: County:

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Daytime Phone: Evening Phone: Cell Phone:

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E-mail: Address:______

Employed by: Years:

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Birth Date: Drivers Lic. # & State:

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Vehicle Make: Color: Year: License:

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Emergency Contact Name: ______Phone:______

Health: _ Fair _ Good _ Excellent

Do you have any medical conditions that our team should know about? If so, please list.

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Have you ever been convicted of a felony? Yes or No If yes please explain:

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Have you ever been convicted of a crime against a child, family violence, or moral turpitude? Yes or No If yes please explain:

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List your SAR related Equipment, Experience, Certifications, Training, or Special Skills:

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Please check each of the following activities you are interested in helping with and/or equipment you own:

_ horse _ canine SAR _ air / pilot _ scuba diving

_ medical _ boat / marine _ search management

_ ATVs _ bilingual-Spanish, etc. _ fund raising / grant writing

_public speaking _ computer/database skills

_ graphic / web design _ search team meals _ printing / copying

_ flyer distribution _ office support skills or writing

_ event plans & support _ carpenter or mechanic _ other activities

No Firearms are allowed on searches. Initials:______

I agree to Acadian Search and Rescue conducting a complete background check if applicable.

I agree that no information withregard to searches will be released to any member of the news media, made public in any way or used for personal useof any kind.

I agree all information, paperwork, or equipment issued, etc. are the property of Acadian Search and Rescue.

I willtake no photographs or video on any sanctioned search or event, without the permission of Acadian Search and Rescue supervisory personnel.

I understand that any tip or information of any kind pertaining to a potential

criminal case must be reported and that removal of anything from a search area may be considered interfering with a criminal investigation, a prosecutable offense.

I agree to hold Acadian Search and Rescue harmless with regard to any personalinjury or injury/theft of horses, dogs or damage to personal property while volunteering for Acadian Search and Rescue.

By my signaturebelow I accept these terms. Membership is a privilege that may be denied or revoked at any time.

Signature: Date:

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