SAR Medical and Parental Consent

If you are applying to join the LCSO SAR Post, please first fill out the main SAR volunteer application. Then have your parent or guardian fill out and submit the following consent form. If you are not a minor, you may fill in the Authorization for Consent for Treatment yourself and disregard the parental consent for membership.

If you are not able to complete the form in one sitting, scroll to the bottom and click the “Save and Continue Later” link. Doing this will save a copy of the information you’ve entered and allow you to return and finish later.

SAR Authorization for Consent for Treatment
Search and rescue missions and training often require a great deal of both physical and mental endurance and sometimes offer an element of risk of bodily harm. Medical clearance for all Search and Rescue volunteers is required by the Linn County Sheriff’s Office. All volunteers are required to report any injuries immediately to members of the Post’s adult leadership. All members of the Linn County Sheriff’s Search and Rescue Post are covered by State Accident Insurance Fund (SAIF) while on official functions and actual search and rescue missions, the same as a full time employee of the Linn County Sheriff's Office.
The following information is for official use only and will not be released to unauthorized persons.
Do you know your blood type?*
- yes
- no
Please specify blood type
Do you currently have any medical conditions?*
Please list any prescribed or other medications or supplements that you are taking:*
Name*
First Middle Last
Age*
Date of Birth*
MM slash DD slash YYYY
Consent of Parent or Guardian*
I certify that I am the parent or guardian of the above-named applicant. By signing below, I give consent for the applicant to receive medical treatment as deemed necessary by the attending physician at any licensed medical facility.
- I certify that I intend my electronic signature on this application to be the legally binding equivalent of my traditional handwritten signature.
Signature of Parent/Guardian*
Enter your full legal name.
Date Signed*
MM slash DD slash YYYY
Email Address*
Please provide an email address where we can contact you if we have questions.
Medical Insurance
Name of Parents or Guardians' Insurance Company*
Group Number
Policy Number
Name of Policy Holder
Policy Issued Through
Primary Care Physician
Name of Primary Care Physician*
Physician City
Physician Phone Number
Alternate Contact
Contact Name*
Name of another person to contact if parents cannot be reached.
Contact Address*
Contact Phone*
Alternate Phone Number
Membership Agreement
Parent or Guardian's Statement
I hereby give my approval for my son/daughter/ward to join the Linn County Sheriff’s Search and Rescue Post. I agree to do my part to support my son/daughter/ward in his or her participation in the Linn County Sheriff’s Search and Rescue Post. I understand that the Linn County Sheriff’s Search and Rescue Post is an emergency service organization committed to the saving of lives and rendering assistance to those in need. I realize that the adult leadership of Linn County Sheriff’s Search and Rescue Post is provided the Linn County Sheriff’s Office and that the Post Advisor is a sworn deputy sheriff.

I understand that the Linn County Sheriff’s Search and Rescue Post, its leaders and sponsoring institution, the Linn County Sheriff’s Office assume no responsibility for injury or loss of life sustained in the course of its activities, except as provided by the insurance policy currently in force.
- I certify that I intend my electronic signature on this application to be the legally binding equivalent of my traditional handwritten signature.
Signature of Parent/Guardian
Enter your full legal name.
Date Signed
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

SAR Authorization for Consent for Treatment

Medical Insurance

Primary Care Physician

Alternate Contact

Membership Agreement