Chino Police Department

Your occupation, hobby, interest, or vocation may be just what your community needs during a disaster. If you are willing to share your knowledge, experience and expertise with those in your community, please complete the registration form below. The information you enter will be stored in a database. Should a disaster occur and a need arise that you can fill you may be contacted and asked to assist.


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Personal Information

Last Name: First Name:

Home Address:

Home Phone:

E-mail address:


Name of employer:


1. Are you a Certified Disaster Service Worker?

No Yes OES Number:


2. Are you currently certified in any of the following areas?

CPR AED First Aid Lifeguard Mass Care/

Other certifications:


3. Do you possess skill or hold a license in any of the following areas?

Sign Language Social Work/ Counseling Pilot
Bus Driver Heavy Equipment Op. Semi-truck Driver
Emergency Medical Tech. Telephone Operator Dispatcher
Medicine Animal Care/Medicine Pastoral Care
Catering/Food Service Child Care Elder Care
Disability Care Construction Amature Radio

Other licenses/skills you possess:


4. Please list below any additional talents, skills and abilities you possess and wish to share with this community:



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