UNIVERSITY DISASTER RISK REDUCTION and MANAGEMENT OFFICE (UDRRMO)

and
MEDICAL SERVICES DEPARTMENT
________________________________________________________________________________
MEDICAL RAPID RESPONSE TEAM (MRRT) APPLICATION FORM
(JUNIOR: STUDENT RESPONDERS)
Name: Age: Sex:

Address: Contact No.

College:
Course (Spell-out):
Emergency Contact Person: (Name, Relationship & Contact Number)

Previous Volunteer Experience (indicate the year):

Trainings Related to Medical and Emergency Response (indicate the year):

Why do you want to join the MRRT and be a volunteer?

Do you have any known health conditions?

By signing below, you agreed that all information provided in this application is true and correct to the best
of your knowledge.

Name and Signature of Applicant Date

Name and Signature of Parent/Guardian Relationship

Manually fill-up this form and submit it to the University Disaster Risk Reduction and Management Office
(UDRRMO) at the Medical Services Department Building.