Monroe Louisiana Mud Out Disaster Relief Trip May 21-28 We will respond to bring help, healing and hope to Monroe, LA. Please volunteer. Your help is needed. Rules - 3 F s: Have Fun; Be Flexible; No Fussing The particulars - Region 2 deployment: Deploy Saturday, May 21, 6 AM depart: IBSA 3085 Stevenson Drive Springfield, Illinois 62703 Return Saturday, May 28, 7 PM return: IBSA 3085 Stevenson Drive Springfield, Illinois 62703 This is the IBSA parking lot. On site Food Provided Showers Provided Bring towels and toiletries Laundry Provided Label clothing with a laundry marker and labeled laundry bag Lodging Provided Road Meals $25 50 Temperature May averages: low 64 high 84 If you leave your vehicle at the IBSA parking lot send me the year, make, model, color and license plate number of your vehicle by May 18. All vehicles will be parked by the Disaster Relief Trailer. Please place Appendix A on the dash of your vehicle. If you need any DR gear, T-shirt, collar shirt, jacket, hat, etc. contact Alexis Dumire alexisdumire@ibsa.org and make arrangements to pick up the gear and payment. I can pick up items from the IBSA office Thursday, May 19 by 11 AM if that will help you. Husband and wife teams are encouraged to go! However, housing will be dormitory style, men s area and women s area, so please plan and pack accordingly. Two coolers will be aboard to place drinks, snacks, sack lunches, etc. While traveling it is appropriate to wear your yellow shirt and cap. We will stop approximately every 2 hours to accomplish the 3 Ss: stretch snack and seek relief. How can I help if I can t go or how can my Church help: Pray for the Team and flood victims Provide a great box lunch (18) Provide soft drinks (16 cases) Provide Gatorade Powder (singles 32-8 packs)
Provide Homemade Oatmeal Raisin Cookies (10 dozen) Provide assorted snacks Provide $ for volunteers that may need trip items they might not be able to afford Appendices: Appendix A Windshield Sign Appendix B Travel Routes Appendix C What to Bring Checklist Appendix D Release and Indemnity Agreement Appendix E Personal Medical Information Form
Appendix A Print and place on the dash of your vehicle Disaster Relief Mud Out Team Member May 21-28 1
Appendix B Travel Routes To Monroe, Louisiana: Springfield, IL. I-55 S Memphis, TN Monroe, Louisiana
Appendix C What to Bring Checklist Devotional Materials Bible and devotionals Hope in Crisis tracts Spiritual Preparation for Disaster Relief Witnessing tracts Identification Disaster relief ID Driver s license Vehicle registration (if driving your vehicle) Phone numbers (family physician, employer, church, emergency contact) Insurance Information (list company, policy number, coverage, agent, and phone) Health Automobile (if driving your vehicle) Miscellaneous Items Money or traveler s checks ($50-200) Notebook and pencils or pens Southern Baptist disaster relief manual and/or state disaster relief manual Clothing (4-7 day supply) Disaster relief caps and jackets Coats and/or jackets (warm and cool) Jeans or work pants Shirts (warm and cool weather) Underwear Sleepwear Sneakers Work shoes Waterproof footwear Socks (2/day; white, wool or wool blend) Work gloves Rain suit or poncho Bandanas and handkerchief Laundry bag Health, Safety, and Hygiene Prescription medicine (List by name all your prescription medications) New prescription orders (if your physician approves and will write new prescriptions) Nonprescription drugs Allergy kit: bees, etc.. Sunblock (15+) Bar soap Liquid antibacterial soap Laundry detergent Deodorant Feminine needs Personal needs Towels Washcloths Mouthwash Toothbrush Toothpaste Dental floss Shampoo and rinse Comb and brush Hair spray Chap stick Shaving cream Razor Diarrhea cure Antacids Laxative Insect spray Skin lotion Blister kit A&D ointment Antifungal ointment/spray Foot powder Food Diet food Snacks Drinking water Supplies and Equipment Flashlight or lantern Bedding (air or foam mattress, cot, and covers) Watch or clock Tent (optional, inquire first) Canteen or water bottle Special personal items you need for health, safety, or comfort
Appendix D Release and Indemnity Agreement I do hereby represent and acknowledge that I am entering upon a missionary venture with others, and that as a volunteer am paying my own expenses, including insurance, for the purpose of helping in times of disaster for the glory of God and to demonstrate my faith in Christ; that the work may at times be hazardous and somewhat arduous and will be performed by concerned volunteers and qualified professionals trained in disaster work; that vehicles transporting said volunteers will be operated by volunteers, who may or may not be professional drivers. I recognize and acknowledge potential accidents at the disaster site, involving motor vehicles, in or about the living, sleeping and eating areas, or during activities of the disaster relief team; am fully aware of possible injuries to members of the disaster relief team, including myself. Therefore, I desire to protect, release, acquit, indemnify, and hold harmless from any and all claims, injuries, damages, losses, expenses or attorney fees incurred by me, my heirs, administrators, executors, or assigns. For and on behalf of myself, my heirs, administrators, executors, assigns, and all other persons, firms, or corporations, I do hereby release and discharge from liability all other persons on the disaster relief team with me, those who notified, selected, or assigned me to the said team, the state disaster relief director or department, the Southern Baptist Convention, their employees and representatives, successors or assigns, from any claims, demands, damages, actions, causes of actions which I, the undersigned, have or may hereafter, and on account of, or any way growing out of injuries or damages both to persons or property resulting or that may hereafter result from the voluntary venture. This waiver, release, and indemnity agreement is fully understood by me and I enter the same willingly for the purposes herein above stated. Volunteer Print name Signature Witness Witnessed, my hand on this the day of, 20 Print name Signature *Insurance Each volunteer is expected to have insurance in case of accident, injury, or illness. No insurance coverage is provided to volunteers by the (state convention). Personal liability is the responsibility of the volunteer.
Personal Medical History & Medication Form Name: Address: Date of Birth: Gender: Home Phone: Cell Phone: Work Phone: Home Church: Address: Church Phone: Pastor: Pastor s Cell Phone: ALLERGIES to Medications: ALLERGIES to Foods, Man-Made Materials, etc.: Insurance Co.: Policy No.: Emergency Contact: Relationship: Home Phone: Cell Phone: Work Phone: Physicians (Health Care Provider(s)): Name Specialty Phone Name Specialty Phone Name Specialty Phone Name Specialty Phone Present Medical History: Past Medical History (include major surgeries) Medications: (Prescription, Supplements, Vitamins, Herbal Supplements, Over-the-Counter) Pharmacy Name & Phone Number
Name: Dose (# milligrams, etc.): No. of Times Day: Route (By mouth, injection, etc.): If you are driving Driver s License No. State If you are driving your own vehicle Auto Insurance Company Policy No. Car License No. State