Volunteer Subscriber Application Form

Please provide the following Contact Information :

Postal Address (If different from physical address) :

Please Identify and Describe Yourself:

Next of Kin / Emergency Contact :

MEDICAL HISTORY:

Please explain any "Yes" response. 
This information will remain highly confidential.

How would you describe your current health?

Blood Group:   

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 Colour 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:

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

Please describe your experience in Medical Services:

OFF - ROAD DRIVING EXPERIENCE:  
(Check each applicable one, whether you own a 4X4 Vehicle or not.)

Any Other Categories:

OFF-ROAD VEHICLE:

Other:

RESPONSE INFORMATION:

8. If Yes, Please explain:

9. Which position are you applying for? (You may select more than one)

4x4 Operative (Transport / Logistics / Communications)
Base Ops (Communications / Incident Planning / Incident Management / Mapping)
General Search and Rescue (Search Management / Admin / Communications)
Field Operative (Mountain Skills / Communications / Rope Rescue)

Please note that Delta Search & Rescue is a volunteer organisation and there will be times
when it will not be possible for you to respond to a callout.  While you are expected
to respond whenever possible, no action is taken against subscribers who are unable to respond.
The demands of family and career are understood and respected by DSAR.

(Please complete section below after printing!)

DELTA SEARCH & RESCUE

AGREEMENT AND WAIVER

I ___________________________________ , am aware that while a subscriber to Delta Search & Rescue,
(also known as DSAR), 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 subscriber on Delta Search & Rescue activities.

I agree to maintain the minimum insurance required by South African law in my home province, on my 
personal vehicle if I choose to drive it on Delta Search & Rescue activities and that I will be responsible
for any and all damage to my vehicle and other property while on Delta Search & 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 Delta Search & Rescue, its directors, subscribers, 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 Delta Search & Rescue 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 Delta Search
& Rescue 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 subscription to Delta Search & Rescue 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 subscription, I must keep
Delta Search & Rescue 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 subscriber to Delta Search & Rescue. 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 subscribers of Delta Search & Rescue.
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 Delta Search & Rescue 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 post or hand the complete application form together with your 
joining and subscription fee of R150.00, 1x I.D. photo and copy of I.D. book to a member of the
Management Team at your earliest convenience.