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Membership ApplicationEmail completed applications to [email protected]
Personal Information
Name: Age:
Address:
City: State: WA Zip:
Email:
Home Phone #: Work Phone:
Cell Phone: Pager:
Emergency Contact Information
Name Relation Type (home, cell, work, other, etc)
Number
Relevant Medical Information (voluntary)Allergies, regular medications or other information that might be relevant.
Email completed applications to [email protected] Page 1
Membership ApplicationFirst Aid & CPR CertificationFirst Aid and CPR must be current and valid for 6 months to be considered for acceptance. Please attach copies of your certificates for your medical training.
Certification Course Name Where Taken Date Completed Expiration
First Aid(AHA/ARC Basic First Aid, or higher)
CPR
Additional Medical TrainingPlease provide details for any advanced medical training that you have completed. (e.g. WFA, WFR, EMT,W-EMT, RN, MD, etc) List the course name, when you completed the course and if your certification is valid. Please attach copies of your certificates for your medical training.
Certification Course Name Where Taken Date Completed Expiration
Email completed applications to [email protected] Page 2
Membership ApplicationPersonal StatementIn 150 words or less, please explain why you are interested in joining SMR.
Climbing or SAR ReferencesPlease provide contact information for a minimum of two (2) individuals who can attest to your climbing skills.
Reference Name Relation Contact Info (home, cell, work or other)
Years Known
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Membership ApplicationMental & Physical Fitness
Psychological Stress Resiliency Self-AssessmentSeattle Mountain Rescue takes operational stress and Rescuer Psychological Resiliency very seriously within our team. As part of our application process, we want to ensure that our prospective members have a basic level of understanding of stress, what their current state is along a continuum, and how they manage or mitigate it on a regular basis.
SMR does not expect new applicants, or even our team’s rescuers, to consistently be “in the Green”. But we want our members to have the capacity to move towards the Green and do encourage our members to self-assess their position along the Rescuer Stress Continuum periodically to be aware of what factors are of influence.
Our Search & Rescue volunteer work has a high potential to slowly move us from left to right along this graph. And SMR hopes our members institute “Green Practices” in their daily lives that help them continually strive to move back towards the left of the Continuum.
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Membership ApplicationIn 100 words or less, briefly describe some of your current stressors that may pull you from left to right on the Stress Continuum.
In 100 words or less, please explain current strategies or “Green Practices” that you use to move back towards the Green on the left side of the Stress Continuum.
Statement of Physical & Mental Fitness Condition AttestationBy submitting this application for membership in Seattle Mountain Rescue, you declare that you are in good physical condition and have no illness or handicap that impairs your ability to participate in physically and emotionally demanding activities.
In addition to the above self-assessments, please visit the following website and complete the Physical and Mental Fitness attestation. There is no unique login required. Simply enter your name, email address and list “Seattle Mountain Rescue” as your agency. Attach the emailed confirmation certificate with your application.
http://www.kcsara.org/training/exams
Email completed applications to [email protected] Page 5
Membership ApplicationMountaineering, Avalanche & Medical Courses Completed
Course/Curriculum Club/School Date Completed
Basic:
Intermediate:
Avalanche:
Other (specify):
NOTE: Attach all certificates for mountaineering, avalanche and medical courses to this application as PDF.
Mountain Climbing Experience: Number of Years: ______
Rock Climbing Experience: Number of Years: ______
Snowshoe or Skiing experience: Number of Years: ______
Other Relevant SkillsProvide information pertaining to skills acquired from survival courses, compass courses, radio licenses, ski patrol, guiding, etc.
Email completed applications to [email protected] Page 6
Membership ApplicationClimbing & Ski Experience ResumePlease provide a resume of mountaineering and technical climbing that demonstrates at least three years of intermediate mountaineering experience. List your climbs (routes, grade, and date) or trips (location, route, and date) as well as your role in leading or participating on those climbs. Add additional rows to the tables, as necessary.
Mountain Climbing Experience
Route Location Grade / Rating
Date Notes
Rock Climbing Experience
Route Location Grade / Rating
Date Notes
Email completed applications to [email protected] Page 7
Membership Application
Ice Climbing Experience
Route Location Grade / Rating
Date Notes
Backcountry Ski & Snowshoe Experience
Route Location Grade / Rating
Date Notes
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Membership ApplicationApplication Attachment ChecklistPlease attach the following as separate PDF files with your application:
⃣ Certificates for any completed Mountaineering Courses⃣ Certificates for any completed Avalanche Courses⃣ Certificates for any completed Medical Courses (AHA/ARC conforming adult
FA/CPR at a minimum)⃣ WA State Attestation of Physical & Mental Fitness (copy of email is sufficient)
If accepted into SMR, you will also be required to provide the following. At that time, instructions for these will be provided and you will have approximately 2 weeks to complete and submit the following to the unit:
Completion of FEMA ICS-100 & 700 is required as mandated by the Revised Code of WA 38.52.400. (This may be accomplished by visiting https://training.fema.gov/nims)
Department of Emergency (DEM) Worker Application DEM ID Card Photo Copy of Driver’s License Copy Vehicle Insurance Card Signed SMR Volunteer Handbook Desired Method for receiving Mission Notification Alerts (default is via mobile and
you may also elect to have them emailed to you)
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