B.C. Wildfire Response 2023 CDR Volunteer Application - Generic Location(Required)Please click or tap in the box to select your preferred shift. If you wish to volunteer for additional weeks/days. Please click or tap in the box to select each day you wish to volunteer for.(Required)This field is hidden when viewing the form I would like to request overnight accommodations Arrival Date/Time MM slash DD slash YYYY Arrival Time12:00 AM12:30 AM1:00 AM1:30 AM2:00 AM2:30 AM3:00 AM3:30 AM4:00 AM4:30 AM5:00 AM5:30 AM6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM10:30 PM11:00 PM11:30 PMDeparture Date/Time MM slash DD slash YYYY Departure Time12:00 AM12:30 AM1:00 AM1:30 AM2:00 AM2:30 AM3:00 AM3:30 AM4:00 AM4:30 AM5:00 AM5:30 AM6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM10:30 PM11:00 PM11:30 PMNote: If you are unable to volunteer for the full duration of the shift, please let us know in the box below.Contact InfoName(Required) First Last Address(Required) Street Address Address Line 2 City Province | State Please select...AlbertaBritish ColumbiaManitobaNewfoundland and LabradorNew BrunswickNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory--AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall islandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Postal Code | Zip Country CanadaUSA Primary Phone #(Required)Primary Phone Type(Required)Please select...CellSecondary Phone #Secondary Phone TypePlease select...CellHomeEmail(Required) Please send me email updates about Samaritan’s Purse initiatives (you can withdraw your consent at any time) Sex(Required)Please choose...MaleFemaleDate of Birth(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you volunteering with a church, organization or group? (optional)Other Church/Organization/Group (optional)Parent/GuardianVolunteers must be at least 16 years of age, and youth ages 16 and 17 must be accompanied by a parent/guardianName(Required) First Last Emergency Contact InfoName(Required) First Last Phone number(Required)Relationship(Required)Please choose...SpouseSiblingParentOtherHealth InfoThis field is hidden when viewing the formProvincial Health Care NumberHealth concerns/allergies or medicationsVolunteer InfoT-Shirt size(Required)Please choose...SmallMediumLargeXLXXL(Required) I have read and agree to Terms of Use and Privacy Policy. For more information or if you have questions please call: 1.800.663.6500 (Required) I have read and acknowledged the Samaritan's Purse Statement of Faith. Acknowledgement of Work(Required) I agree to the statement belowThis is a test ackowledgement of work messagefalse 0565982a-9842-ee11-ad19-005056bad56d </ p >