Disaster assistance volunteer registration form

When a disaster strikes, individuals want to do something to help. This often creates the challenge of having many people who want to assist, but do not know how to help.

The Mass Care Task Force (MCTF) is an innovative collaboration between the American Red Cross North Texas Region, North Texas Food Bank, the Salvation Army DFW Metroplex Command and the Volunteer Center of North Texas. One of our goals, at the Volunteer Center of North Texas, is to prepare individuals to help before a disaster occurs.

Be among the first to pre-register to volunteer and have access to training to respond to those in need. More than 28,000 volunteers are needed to support this effort and we cannot do this without your help!

Please complete the form below. Items with a red * are required.
*Last Name:
*First Name:
*Date of Birth
mm/dd/yy  
*Phone
Alternate Phone:
*Mailing Address:
Street:
City:
State:
ZIP:
County:
*Email Address  (this will be used for your username):
*Password:
*Re-enter Password:
*Emergency Contact First Name:
*Emergency Contact Last Name:
 
*Emergency Contact Phone Number:
Placement Preference:

Push and hold CTRL to select multiple skills.
College/ University Affiliation:
Demographic Information. This information assists us in future funding opportunities and grant reporting requirements.
*Gender:
*Ethnicity:
Employer:
If employer not listed, please select other and fill out the box below
Language:
Secondary Language:

Push and hold CTRL to select multiple languages.
 
Special Accommodation Needed:
Accommodation Required:
Impact Area:

Push and hold CTRL to select multiple impact areas.
Skills:

Push and hold CTRL to select multiple skills.
 
Please select any specific disaster skills you possess. We may or may not have these specific needs as each disaster response is different.
Disaster Skills:
Push and hold CTRL to select multiple skills.
Comments:

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