2017 Alaska Experience

Transcription

1 Registratin Frm Serve ne anther in lve. GALATIANS 5:13 ( NLT) Jin Us in Alaska fr a week f service as we learn abut American Baptist hme missin wrk in the last frntier. Highlights include: Learn abut and experience American Baptist missin in Alaska Participate in hands-n missin experiences Opprtunities t encurage and supprt thse in need Opprtunities t wrship with lcal American Baptist cngregatins Opprtunities t see the beauty f Alaska Fr mre infrmatin n hw t be invlved in this exciting week, please cntact: Victria Gff at r vgff@abhms.rg, PO Bx 851, Valley Frge, PA Friday, August 25, 2017 Mnday, September 4, 2017 Legal Name Lcal Church Hme Address Hme Phne Office Phne Emergency Cntact Cell Phne Phne f Birth Please list all medical allergies Please list all fd allergies Please list all medicatins yu are currently taking Cst: apprximately $1,800; includes transprtatin, husing and fd Please return this frm with yur nnrefundable depsit f $100 by June 19. Final payment is due July 17, PO Bx 851 Valley Frge PA Fax Phne Fr credit card payments, please call

2 Participant Liability and Medical Release Frm Serve ne anther in lve. GAL ATI ANS 5:13 ( NLT) Please read befre signing as this cnstitutes the agreement and the understanding f yur wrking relatinship as a vlunteer. I, acknwledge and state the fllwing: I have chsen t travel t perfrm a variety f tasks, sme f which maybe cleanup/cnstructin wrk. I understand that this wrk may entail a risk f physical injury and culd invlve physical labr, heavy lifting and/r ther strenuus activity; and that sme activities may take place n ladders and building framing ther than grund level. I certify I am in gd health and physically able t perfrm this type f wrk. I understand I am engaging in this experience at my wn risk. I assume all risk and respnsibility fr any damage r injury t my prperty, r any persnal injury and related medical csts and expenses which I may sustain while invlved in this experience. I understand that I am t abide by whatever rules and regulatins may be in effect fr the accmmdatins at that time. I further understand that sme accmmdatins may include staying in persnal residences with hst families. By my signature, fr myself, my estate and my heirs, I release, discharge, indemnify and frever hld harmless and American Baptist Churches f Pennsylvania and Delaware, tgether with its fficers, agents, servants and emplyees, frm any and all causes f actin arising frm my participatin in this experience, and travel, r ldging assciated therewith, including any damages which may be caused by their negligence. Signature Arrival Departure Team Leader

3 Medical Infrmatin and Release frm Serve ne anther in lve. GALATIANS 5:13 ( NLT) MEDICAL COVERAGE: I understand and acknwledge that n medical r ther insurance r health care benefits will be prvided t me by the and American Baptist Churches f Pennsylvania and Delaware, during my participatin in 2017 ABCOPAD Alaska Experience, and I certify that I have sufficient health, accident and liability insurance r ther benefits t cver any bdily injury r prperty damage I may incur while participatin in 2017 ABCOPAD Alaska Experience, and t cver bdily injury r prperty damage caused t a third party as a result f my participatin in 2017 ABCOPAD Alaska Experience, as fllws: Cmpany Plicy # Address MEDICAL RELEASE: I hereby state that I am in gd health and have all medicatins necessary t treat any allergic r chrnic cnditins, and I am able t administer such medicatins withut assistance. If at any time during my participatin in 2017 ABCOPAD Alaska Experience I need emergency medical care and am nt able t give cnsent because f my physical r mental cnditin, I authrize and American Baptist Churches f Pennsylvania and Delaware, t make emergency medical care decisins n my behalf, and I specifically release the American Baptist Hme Missin Scieties and American Baptist Churches f Pennsylvania and Delaware in making thse emergency medical care decisins, frm any and all liability assciated with said decisins, even if injury r death is the result f the American Baptist Hme Missin Scieties and American Baptist Churches f Pennsylvania and Delaware alleged negligence. Persn t be ntified in case f injury: Name Phne Number ALL PARTICIPANTS MUST SIGN: My signature belw indicates that I have read this entire dcument, understand it cmpletely, and agree t be bund by its terms. Signature f Participant Executed SIGNATURE Of PARENT/LEGAL GUARDIAN IS ALSO REQUIRED If PARTICIPANT IS UNDER 18 YEARS Of AGE: Signature f Parent/Legal Guardian (if applicable) Executed SIGNATURES MUST BE WITNESSED: Signature f Witness Executed

4 Pht, Audi and Vide Release Frm Serve ne anther in lve. GAL ATI ANS 5:13 ( NLT) I hereby give permissin fr audi and visual images f me and/r my child under age 18, captured during regular, and American Baptist Churches f Pennsylvania and Delaware, activities thrugh, audi, pht and/r vide recrding means, t be used slely fr the prmtinal material, multimedia and publicatin purpses f the and American Baptist Churches f Pennsylvania and Delaware, and waive any rights f cmpensatin r wnership theret. Vlunteer Signature Parent/Guardian Signature

5 Skills Assessment Frm Serve ne anther in lve. GALATIANS 5:13 ( NLT) Name T use yur time and talents t the greatest benefit while yu are vlunteering, please indicate yur current skills and experience, as well as the level f thse skills by using the fllwing: Skill Levels 0 = I am unable t d, r am nt interested. 1 = I d nt knw hw, but am willing t learn r try. 2 = I have dne it befre, but still need help t cmplete. 3 = I can d a gd jb by myself. 4 = I can d a gd jb, and can guide r teach thers. 5 = I am a licensed cntractr. Skills Indicate level, using apprpriate numbers identified abve. Carpenter Clean-up wrker Clerical Cmputer skills Cntractr Drywall Hanger Drywall Finisher Electrician Flring Carpet Flring Underlay Flring Vinyl Framing Hspitality Insulatin Landscaping Masn Painting Plumbing Rfing Siding First aid trained CPR trained Are yu a nurse? yes n Are yu a physician? yes n Other skills r cmments