Capital District Street Medic Collective

Capital District Street Medic Collective
Name
First NameLast Name
Pronouns
Email
example@example.com
Phone Number
Area CodePhone Number
Have you been added to the signal chat?
YesNo
Address
Street Address Line 2
CityState / Province
Postal / Zip Code

The Capital District Medical Collective and Albany General Defense Committee our police abolitionist organizations. By participating in actions with these organizations you agree not to communicate nor collaborate with police in relation to our medic activities.*
I agree to the community agreement

How would you describe your medical experience? Please provide list of trainings completed, certifications (valid or expired-date), licenses (valid or expired-date).
Trainings
Certifications
Licenses

Please review our medic pack list.
Do you have a complete first aid kit?
YesNo
If you have a first aid kit but need items to meet the pack list, list here:
Do you need financial or material help to establish a first aid.
YesNo

What advanced equipment do you have (advanced first aid/gas mask/radio)
What is your general availability for attending events?
Do you have the ability to attend last minute announced events? If so what sort of general availability do you have for that?

Arrest information (please provide for jail support in the event you are arrested).
Emergency Contact 1
Emergency Contact 2
List medications we should ensure you have access to.
Medical conditions to be communicated to police.
Should be Empty: