Medical Team Application

Contact Info
Name *
Name
Phone Number *
Phone Number
Address *
Address
Church Involvement
Are you a Faith Church member? *
Date joined *
Date joined
Vocation
Experience
Date of last CPR/AED training? *
Date of last CPR/AED training?
Have you ever performed CPR on a real patient? *
Have you ever used an AED on a real patient? *
Christian Life Information
References
Please provide the names and contact information for two (2) personal references.
Reference 1 - Name *
Reference 1 - Name
Phone Number *
Phone Number
Reference 2 - Name *
Reference 2 - Name
Phone Number *
Phone Number
Please submit the following items to Jeff Grant, Operations Pastor: *
(1) Medical License (2) CPR card (3) Child Abuse Training Certification