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kkemp
2019-05-23T17:20:39+00:00
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NAME:
Email Address:
Mobile Phone Number:
If a Worship Center Security, Volunteer, Staff, or Health Team Member:
No
Yes
Organization:
*
Role:
*
Are you a School Leader, School Nurse, or Representative:
No
Yes
School:
Role:
Are you a Scout or Scout Troop Leader or Parent:
No
Yes
Troop or Pack:
Are you an Eagle Scout?
Designate Scout or Scout Leader
Are you a Boy Scouts of America Orange County Council Staff or Volunteer:
No
Yes
Role:
Department and Location:
Are you a Professional First Responder or Caregiver:
No
Yes
Lifeguard:
Security Detail:
Professional Healthcare Worker:
Other:
Are you CPR/AED Certified:
Not Certified
American Heart Association Certified
American Red Cross Certified
Date Certified (Optional)
Do you have Stop the Bleed Training Certifications
Not Certified
Stop the Bleed Certified
Stop the Bleed Instructor
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