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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