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Temporary Emergency Worker Registration Card / COVID-19

  1. Temporary Emergency Worker Registration Card
    Mission Number 20-0265 Assignment: COVID-19 Response - Face Coverings Making, Donation, Distribution
  2. EMERGENCY CONTACT INFORMATION
  3. Please check all fields and ensure the information is correct and not incorrectly auto-populated.*
    Please check the box, once you have confirmed the information is correct.
  4. Parent or Guardian Name
    If the applicant is under the age of 18 years old, the parent or guardian gives permission for their child to be a Temporary Registered Emergency Worker for the Office of Emergency Management for the listed task.
  5. Please list what task the child will be completing as a Temporary Registered Emergency Worker.
  6. If the applicant is under 18 years old, the guardian or parent must fill out the below section.
    As the parent or guardian of the above applicant, I give permission for my son or daughter, who is named above, to register as a Temporary Emergency Worker with the Everett Office of Emergency Management for the task listed below.
  7. Leave This Blank:

  8. This field is not part of the form submission.