Catskills Hatzalah Questionnaire

First Name

Last Name

Cell Phone

Email Address

Street Address

City

State

ZIP Code

Location / Camp / Colony

My location is not listed

Are you in the Catskills on weekdays (Mon–Thu)?

Are you frequently in the Catskills during the winter (December–March)?

Are you a member of another Hatzalah agency?

Agency

Unit Number

Year-Round Occupation

Summer Occupation

Comments (Optional)