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First Name
Last Name
Phone Number
Email
Gender
Male
Female
I'd rather not say
Do you have any medical training or certifications? (Check all that apply)
CPR/AED Certified
First Aid Certified
EMT/Paramedic
Nurse (LPN, RN, etc.)
Physician/PA
Other
Do you have experience responding to medical emergencies?
Are you comfortable providing basic first aid and emergency care?
Yes
No
Unsure, but willing to learn
Are you willing to serve during church services and events?
Yes
No
Maybe
How often would you be available to serve?
Weekly
Biweekly
Monthly
As needed
Is there anything else we should know about your skills, experience, or availability?
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