SHAWN HORNBECK SEARCH AND RESCUE TEAM MEMBERSHIP APPLICATION...  
Applications must be complete, correct and signed to be considered!

The Shawn Hornbeck Search and Rescue Team does not determine member eligibility based on sex, race, creed, persuasion and or religion. All applicants must be a minimum of eighteen (18) years old, have received no dishonorable discharges from military service and must not be convicted of any felony. Applicants must be physically capable of performing the activities for which they are applying. Your application will be reviewed and you will be contacted with further information concerning the specific areas for which you are seeking membership.

Please provide the following Contact Information:

First Name: 
Last Name: 
Title: 
Street Address: 
Address (cont.): 
City: 
State: 
Zip Code: 
Work Phone: 
Home Phone: 
FAX: 
Cell Phone: 
E-mail: 

Postal Address (If different from physical address):

Postal Address: 
City: 
State: 
Zip Code: 

Please Identify and Describe Yourself:

Date of Birth: 
Sex:   Male   Female
Height: 
Weight: 
Employer: 
Occupation: 
Driver's Licence No: 
Expires:  -- mm/dd/yy

Next of Kin / Emergency Contact:

Name: 
Relationship: 
Address: 
City: 
State: 
Work Phone: 
Home Phone: 

MEDICAL HISTORY:
 This information will remain highly confidential.

Please explain any "Yes" response.

How would you describe your current health?

Blood Type:

How would you describe your current physical condition?

Do you now have or have you had any serious medical condition?
 Yes     No

Have you been hospitalized in the past year?
 Yes     No

Do you have any other medical or health condition which might adversely affect you in the field?
 Yes     No

If Yes, please select one of the following options that may apply:
 Physical    Visual

Are you Color Blind?
 Yes     No

List any allergies or medications you are currently taking:

EXPERIENCE AND TRAINING:

Check any areas in which you have had any Experience and or Training:
4x4 Driving Operation
Flying (as a pilot)
Search and Rescue
Abseiling
Incident Command
Search Dogs
Backpacking/Hiking
Interview Skills
Horseback Riding
Search Fundamentals		 Caving
Land Navigation/Compass
Search Management
Cave Rescue
Law Enforcement
Survival
CISD
Map Reading
Swift Water Rescue		 Communications
Public Information/Relations
Tracking
Disaster Response
Rope Rescue, Basic
Other (please specify)
Firefighting
Rope Rescue, Hi-Angle
ATV Operations

MEDICAL TRAINING BACKGROUND:

Please identify your current medical certification level, training, or experience (if any).

CERTIFICATION TYPE / LEVEL CERT. NO. EXPIRES
FIRST AID
CPR
BAA (Level 5)
AEA (Level 6)
MD, RN (Level 7>)

Please describe your experience in Medical Services:

RESPONSE INFORMATION:

  1. Would you be able to respond to a call in the middle of the night?
 Yes     No
  1. Would you be able to respond to a call overnight in bad weather?
 Yes     No
  1. Does your spouse and family understand the conditions of this application?
 Yes     No
  1. Do you understand that calls may come at various times of day or night?
 Yes     No
  1. Do you understand that if at all possible you would be expected to respond to callouts (Barring family and work emergencies)?
 Yes     No
  1. Do you understand that, once accepted as a member, you will be expected to attend training and exercises on a regular basis?
 Yes     No
  1. Do you have any other emergency-response commitments that might create a conflict?
 Yes     No

  1. If Yes, Please explain:
  1. Which position(s) are you applying for? (You may select more than one)

Command Center Operations - Administration/Communications/Mapping/Incident Management/Transportation
Search & Rescue - Search Management/Ground Search Operations/Ground Rescue Operations/Search & Rescue Training
K-9 Search & Rescue - K-9 Search Management/K-9 Search Operations/K-9 Training
Dive Team - Dive Operations
Search Support Services - Logistical Services/Administrative Functions/Meal Preparation

Please note that The Shawn Hornbeck Search and Resuce Team is a volunteer organization and there will be times when it will not be possible for all personnel to respond to a callout. While you are expected to respond whenever possible, no action is taken against members who are only able to make a reasonable percentage of training and callouts.

The demands of family and career are very well understood and respected by SHSART.

(Please complete section below after printing!)

THE SHAWN HORNBECK SEARCH AND RESCUE TEAM

I ___________________________________ , am aware that while a member of The Shawn Hornbeck Search and Rescue Team, (also known as SHSART), I may be participating in and responding to activities that are inherently dangerous, including, but not limited to, the hazards of traveling in wilderness terrain, accidents or illness, the forces of nature and travel by automobile, aircraft or other conveyance. I understand that, except when otherwise provided, insurance, workman's compensation, and liability coverage is not provided and that I am solely responsible for any injury, illness, or other medical care required by myself while participating as a member on SHSART activities.

I agree to maintain the minimum insurance required by law in my home state, on my personal vehicle if I choose to drive it on Shawn Hornbeck Search and Rescue activities and that I will be responsible for any and all damage to my vehicle and other property while on Shawn Hornbeck Search and Rescue activities. I do these things entirely on my own initiative, risk, and responsibility, and assert that I will do nothing that is beyond my training and expertise. In consideration of the benefits to be derived, I do hereby for myself, my heirs, executors, and administrators, release and forever discharge Shawn Hornbeck Search and Rescue Team, its directors, members, officers, and agents, from any and all claims, demands, actions, or causes of action, on account of my death or injury, or for damage to my personal property, as a result of my participation in Shawn Hornbeck Search and Rescue Team activities.

I understand that if I do not feel comfortable or competent in a given situation, it is solely my responsibility to ensure that I stop the activity immediately and in a safe manner.  I hereby agree to abide by all rules, regulations, policies, and procedures prescribed for in the subscription to Shawn Hornbeck Search and Rescue Team and I understand that I may be terminated from said subscription for any cause, at any time, upon written notice to myself, mailed to me at the address given on this application for subscription.

I understand that I may voluntarily terminate my membership to Shawn Hornbeck Search and Rescue Team at any time upon written notice mailed to the organization's usual mailing address, or delivered to any director of the organization, by any means.  I understand that, in order to maintain an active membership, I must keep Shawn Hornbeck Search and Rescue Team appraised of any changes in name, mailing address, or telephone number, etc and pay any subscription and/or radio fees prescribed.

I desire to become an active member to Shawn Hornbeck Search and Rescue Team. I agree to attend the required number of training lectures / classes to establish and maintain my ability as a competent subscriber of this organization and to acquaint myself with the duties and other members of Shawn Hornbeck Search and Rescue Team. I have read and understand the requirements of this application to become a subscriber to this organization, and promise to abide by and adhere to the Procedures, by-laws and all operational rules and regulations as set forth by Shawn Hornbeck Search and Rescue Team to the best of my ability. Additionally, I attest that all the information provided by me on this application is true and correct to the best of my knowledge, acknowledging that providing false or fictitious information may result in my immediate dismissal from the organization upon discovery of such.

I UNDERSTAND AND FULLY AGREE TO THE ABOVE:

SIGNED AT : ____________________________________________________

DATE : __________________________________

INTRODUCED BY : _______________________________________________

APPLICANT'S SIGNATURE : _______________________________________

WITNESS : ______________________________________________________

Please sign the section above and mail or hand deliver at either the Shawn Hornbeck Foundation office, the Richwoods SAR Command Center or at any of the events that the Foundation or SAR Team is present at. Please also include the following with your application:

Joining/Subscription Fee of $35.00
( Fees will be used for NASAR Membership and Application Processing )

Copy of: 2x Photo I.D.'s or 1 Photo I.D. and 1 other official I.D. source

I verify that the above information is correct and know that the Shawn Hornbeck Search and Rescue Team may issue a background check to verify the above information that is being submitted for accuracy.