New Member Application – Custer County Search & Rescue

Full Name *

Address *

City, State, Zip *

Cell Phone Number *

Cell Service Provider *

Home Phone Number

Email *

Date of Birth *

Driver's License Number *

State Issued *

DL Expiration *

Emergency Contact *

Emergency Contact Relationship *

Emergency Contact Phone Number *

Please visit our website and read the New Members page in full before completing the remainder of your application. Review our training information, policies and procedures, and past mission information. Type below the date visited: *

How did you hear about CCSAR? *

If you know any team members, who are they?

What Training/Certifications do you hold? (e.g. CPR, medical, mountaineering, etc.) *

Any other qualifications or relevant experiences? *

Please list Equipment & Type that you have experience with or own (e.g. GPS, climbing gear, snow gear, etc.) *

Is there any medical information which may impact your safety or the safety of others while performing SAR activities? Include your physical condition, limitations, medications, and allergies. *

Have you ever been convicted of a felony? *

Do you have an active restraining order against you? *

As an applicant to Custer County Search and Rescue, I authorize the Custer County Sheriff’s Department to conduct a personal background check. Falsification of application information is grounds for membership denial or dismissal. By typing my full name below, I agree to the above statement. *

Email *

Name