Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Emergency Volunteer Registration Form

  1. Authorization for Release of Information

    By checking the box below, I acknowledge and agree that I am freely volunteering my services to the City of Burnsville to assist in and during the current emergency or disaster. I acknowledge and agree to act under the direction and control of the City’s Emergency Manager, or his/her designee, and if I fail to act in accordance with the direction and control of the City’s Emergency Manager, or his/her designee, I will be dismissed as a volunteer and I shall leave the area immediately. Finally, I acknowledge and agree to indemnify and hold the City harmless for any injury, harm or damage caused by or to me, except as otherwise protected under Minn. Stat. §12.22. I further acknowledge that I understand the type of work that is required and I self certify that I am able to complete these tasks.

  2. Click Yes to Agree*

  3. Contact Information

  4. Abilities:

    Check all that apply.

  5. Emergency Contact Information

  6. By checking "Yes," I agree to allow the Burnsville Police Department to run a Minnesota Criminal History Check on me for the purposes of determining my suitability for this program. I hereby acknowledge that I have completed the above information fully and accurately.*

  7. Volunteers Under 18: I give permission for my child to participate.


  8. Leave This Blank:

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