Sea Mercy Captain Form

Sea Mercy Captain Submission Form

For those interested in being considered for either the Sea Mercy Captain program for the Floating Health Care Clinic, First Response Fleet (Caribbean or South Pacific), or the RISE program, please complete the below form to the best of your ability.

First, last, and middle
If applicable.
Home mailing address
Best number to reach you
Please select either FHCC, Disaster Response, RISE, or All.
Please provide us with your resume/CV detailing your experience and background.
Which South Pacific or Eastern Caribbean (CB) island nations are you willing to operate an FHCC in? Use "Cntl" key for multiple selections
Any online information or links that can help showcase your vessel
Monohull, Catamaran, or Trimaran
What year was the vessel originally launched?
i.e. Custom design, Lagoon, Sunreef, Leopard, etc.
Please attach a picture of your vessel, to send more pictures, email them to seamercyorg@gmail.com (include the name of the vessel). Files accepted (gif, jpg, png, bmp, eps, tif, pdf, doc, ppt). Max file size is 4 MB.
Where is your vessel currently located (Country, City)?
What best describes the length of your vessel in feet?
How many volunteer staff will your vessel be able to carry?
To justify and facilitate the rotation of volunteers and supplies, we have an initial 4 consecutive weeks minimum service between "time off" breaks (you determine length of breaks), if you are available or willing to operate for longer consecutive periods, please specify.
What is the weekly operational assistance/charge that you are seeking from Sea Mercy in order to operate your vessel as a FHCC? When calculating this number, do not include the cost of fuel, food (for crew and volunteers), or license and fees while in island nation (these will be covered by Sea Mercy).
Please use this text area to include any additional information or questions regarding the Sea Mercy Captain program.
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