Mailing List

Email List

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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