Lutheran Disaster Response Network of Northeastern Pennsylvania

Disaster Response Form For Congregations

Please fill out the form as completely as possible to have your information added to the Lutheran Disaster Response Network- Northeastern Pennsylvania Data Base (TEAM). The areas marked in red are required in order for the form to process.

For further information about volunteering or filling out this form, call Ruth or Dianne at 610.770.9205 or email them at ruth@lutherancongregationalservices.org or dianne@lutherancongregationalservices.org.

Name of Congregation:

Address:
City:
State:
ZIP:
   
Mailing Address (only if different from above)
   
Address:
City:
State:
ZIP:
   
Mission District:
County:
Telephone:
Fax:
Email:
   
Pastor's Information
   
Name:
Telephone:
Beeper/Cell Phone:
Email:


We will use the information you provide as part of our disaster preparedness planning.

1. Are you also interested in volunteering for the current rebuilding from flooding along the Delaware?

2. Are you interested in volunteering to help with the Katrina/Rita/Wilma recovery in the southeast?

3. Are you willing to be considered for other disaster assistance outside Northeastern PA?


Congregation Disaster Contact Person
   
Name:
Title/Position:
Telephone:
Beeper/Cell Phone:
Fax:
Email:
Address:
City:
State:
ZIP:
   
In the event of a disaster, our congregation could provide: (check all that apply)
 
SHELTER
Church Building
Retreat Facility
Parsonage
Other Church Property
 
If other than church building, please give the location:
Address:
City:
State:
ZIP:
County:
   
FOOD  
Meals at the Church
Meals at Disaster Site
Food Bank
Cooks
Do you already have a food bank in place?
   
FURNATURE, CLOTHING AND EQUIPMENT
Clothing Bank
Furnature Bank
Medical Equipment/Supplies
Vehicles (vans/buses)
Internet Accessible Computers
Cell Phones
Other
Do you already have a bank of clothing, furniture or medical equipment/supplies in place?
   
CLEAN-UP
Work Groups
Carpenters/Electricians/Plumbers
Cleaning Supplies
Maintenance Staff
Have any of your groups worked on disasters or in a work camp before?
   
PASTORAL SERVICES
Would your pastor be willing to provide pastoral services:
For local disaster
For disaster outside of our synod
What kind:  
Preaching
Pulpit Exchange
Counseling
Other
   
MEMBER RESOURCES  

Counselors
Social Workers
Deaf Interpreters
Clerical Workers
Stephen Ministers
Parish Nurse
Other Trained Volunteers

   
MEDICAL PERSONNEL  
Doctors
Nurses
EMTs
Dentists
Other Medical Personnel:  
   
OTHER SERVICES AVAILABLE: