Spiritual Care Worker Training
REGISTRATION FORM
Please provide the following information:
GENERAL INFORMATION:
Name: ______
LastFirstMiddle
Address: ______
StreetCityStateZIP
Home Phone: ______Mobile: ______Pager:______
E-Mail: (1) ______(2) ______
Faith Community: ______
Local House of Worship: ______
Employer: ______
Position: ______
PRIOR EXPERIENCE
General Chaplaincy/Spiritual Care (hospital, first response, school, house of worship, other):
Where: ______# years______
Disaster Chaplaincy/Spiritual Care:
Where: ______# years ______
PRIOR TRAINING: Chaplaincy/Emotional & Spiritual Care
Where: ______When:______
Where: ______When: ______
ENDORSEMENT OF FAITH COMMUNITY
Credential/Certificate/Letter of Recommendation:______
Endorsing Entity: ______
Contact Person: ______Contact Information:______
Registration Form, p. 2
TRAINING OBJECTIVES
Spiritual Care Worker training prepares “lay” leaders and caregivers to provide basic spiritual and emotional care during deployment in emergency settings such as mass-care facilities, evacuation centers, and Point of Distribution (POD) sites, as well as within their own house of worship or religious institution. Designed as a half-day or evening session, this training provides a basic introduction to Disaster Spiritual Care, Disaster Mental Health, and Self-Care, in an interactive format. Prerequisite: 1) Endorsement, in writing, by the senior religious leader in your house of worship or religious institution. 2) Completion of FEMA’s on-line IS 100 course on the Incident Command System.
GUIDELINES: NDIN-trained Spiritual Care Workers agree to conform to the following guidelines during their deployment:
- Follow the Incident Command System structure,respecting the chain of command
- Respond sensitively to the needs of ALLwho are affected regardless of nationality, race, religion, belief, class, or sexual orientation
- Refrain from proselytizing, sermonizing, or promoting a particular religion or world view
- Recognize their personal and professional limits,working closely with other disciplines such as Disaster Mental Health
- Speak to the media only when authorizedby their team leader.
If you commit to following these guidelines while serving as a Spiritual Care Worker,PLEASE SIGN HERE:
Name: ______Date: ______
PLEASE SEND THIS COMPLETED FORM TO: Ruth Wenger at OR Fax: 347-284-0054OR NDIN, Suite 604, 4 West 43rd St, New York, NY10036.
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