info for new cavers:

membership resources:

club events:

committees:

club files:

online resources:

email discussion list

Vpi Cavers.net

Interactive club history

rescue roster

rescue roster info form

caving links:

NSS

Virginia Region

VPI Rescue Roster Info Form

The purpose of this form is to provide our rescue coordinator with all of the information needed to conduct a rescue call-out. This gives the coordinator names, phone numbers, and experience levels to make sound decisions on the order of call-out, etc. Please complete this form to the best of your knowledge. You do not need to be a full member to be included in our call-out process.

Please view the rescue roster here.

Date:
This is an original submission an update to a prior submission

If this is an update, fill in your name and ONLY the information that has changed.

Personal

First Name: Last Name:

VPI Member Status: Full Associate Trainee

E-Mail Address:

Height: (F'I") Weight: Age Sex Male Female

Addresses

Permanent

,

Temporary

, Until:

Phone Numbers

Permanent:	Work:	Temp:
Cellular:	Pager:

Please list two other numbers of friends or relatives who may be able to contact you.
Alt. #1 Name: Phone: Relationship:
Alt. #2 Name: Phone: Relationship:

In Case of Emergency, Please Contact

(This section MUST be filled in by everyone.)

Name: Phone: Relationship:

Cave Rescue Experience/Training

About how many cave rescues have you participated in?	What level of training have you completed? Please check highest level.
What is your strength on a rescue?	VPI Practice Rescue
Stokes Handler	Basic Cave Rescue Orientation
Medical	NCRC LVL-I Team Member
Ropework	NCRC LVL-II Team Leader
Communications	NCRC LVL-III Specialist
Under Ground Coordinator	NCRC LVL-IV Instructor
Above Ground Coordinator	Other Cave Rescue Training / Rescue Group Memberships:
Other	Other Cave Rescue Training / Rescue Group Memberships:

Medical Training

CPR	EMT	Certifying State:
Basic First Aid	WEMT	Certificate #:
First Responder	RN	Expiration: (MM/DD/YY)
Advanced First Aid	PA	Additional / Other Medical Training:
	LPN
	MD

Cavers Only

Grotto Affiliations: VPI Number:

Do you own a car?
Yes; How many can you take besides yourself?
NO

What rope lengths (in feet) do you have?

Are you acustomed to 10 hour or longer cave trips?
Yes
NO

Are you equipped for and capable of long (8 hours plus) cold, wet (wetsuit) caving?
Yes
NO

Are you vertically proficient? (This implies owning your own ascending/descending system, familiarity with rope calls, the ability to perform changeovers and negotiate rebelays.)
Yes
NO

Other Caving Skills or Equipment Information:

Caves you know well (5 or more trips):

This form was originally written for Nittany Grotto by Michael Glass and was modified for VPI Cave Club by Sandy Knapp with his permission.


	Take Nothing but Pictures, Leave Nothing but Footprints, Kill Nothing but Time
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