March 2022 - QLD & NSW Chaplaincy Flood Response - 2022 - Chaplaincy Australia

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March 2022 - Flood Disaster Response Form

March 2022 - Flood Disaster Response Form - Availability

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State Postcode

Phone(Required)

Email(Required)

Are you a current Chaplaincy Australia Chaplain?(Required)

Yes

No

Have you had previous Chaplaincy experience/training in a Disaster or Recovery situation?(Required)

Yes

No

If you answered "Yes" to the previous question, please provide details below.(Required)

Are you willing to be deployed to a Disaster or Recovery setting for a period of 6 days?(Required)

Yes

No

If you answered "No" - hold long would you you be available?(Required)

Please indicate your availability dates (click all that apply)

27th March - 2nd April

2nd-9th April

Different dates in this period

Which dates are you available?(Required)

I understand that this all reasonable expenses will be reimbursed (Travel, Accomodation and Food).(Required)

Yes

I understand that this is a voluntary (unpaid) position.(Required)

Yes

I agree to follow the direction of my Team Leader and uphold the CA code of Conduct.(Required)

Yes

I understand that completing this expression of availability is not a guarantee of deployment.(Required)

Yes

Δ

Chaplaincy Flood Response Availability March 2022

We are planning our response to the recovery phase of this disaster in QLD and NSW.

Please complete the form with the details of your availability to respond.

Thank you in advance!

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