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Disaster Response Volunteer Application

Please indicate which you are(*)
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**Please note: Each individual member of a team must complete an application**

First Name(*)
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Last Name(*)
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Number where you can easily be reached.(*)
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May we send urgent updates via text message?(*)
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Email(*)
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Name of Church or Organization
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City and State of Church or Organization
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If you are the leader, what is the approximate group size? Please have everyone on your team fill out this form.
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What dates are you available to serve? Option 1
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What dates are you available to serve? Option 2
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In which Disaster Response location do you wish to serve? Please list a specific location or recent disaster whose Disaster Response team you wish to join.(*)
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To which specific opportunity from CBF's Disaster Response website are you applying?(*)
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What skill sets or abilities do you have that would be helpful for this ministry?(*)
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Please indicate desired ways to engage:(*)
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Please include name and relation to you for a person serving as an Emergency Contact:(*)
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Emergency Contact Number(*)
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All Disaster Response volunteers are required to obtain supplemental insurance through Gallagher Insurance Company. TYPE the following URL into your browser in another window to obtain travel insurance: https://app.travelwithgallagher.com/Account/Login

Place your initials in the box to confirm you have or will buy supplemental insurance:(*)
Please let us know your message.

Listed below are sections of our Liability Release Waiver. Please read and initial each section in the provided spaces to indicate compliance. If you require an additional copy of this waiver please contact our office.

I hereby request permission to assist as a short term (volunteer) worker, in the charitable and religious work of CBFResponds of the Cooperative Baptist Fellowship (the “CBF” or “Fellowship”), a non-profit organization. I understand that in rendering such assistance, I shall under no circumstances be deemed an employee of the Fellowship for any purpose, and furthermore, understand that all expenses incurred during said short term work will be the responsibility of each participant not the responsibility of the Fellowship.

Place your initials here:(*)
Please let us know your name.

I understand that certain dangers that result from my travel in the pursuit of short term mission service are unforeseeable, such as illnesses/injuries without access to adequate medical facilities for treatment, or political unrest that may result in injury, imprisonment or death. Accidents may occur with no advance notice. Hostilities may result in my being held hostage, or being stranded and not being able to return to home. I understand that this list of dangers is not comprehensive. I understand that the dangers are beyond the control of the Fellowship and/or ministry partner, but I still desire to participate in this mission endeavor. I recognize that the Fellowship’s policies may, and/or the situation itself, prohibit it from intervening on my behalf should a calamity arise. I recognize that the Fellowship will not pay any amounts to remedy my situation, including the payment of ransom or bribes. In consideration of the grant of permission by the Fellowship,I agree that I shall perform such work at my own risk.

Place your initials here:(*)
Please let us know your name.

I recognize most United States insurance policies do not cover me outside the United States and that I am responsible for securing medical insurance to cover my activities on the trip beyond the minimal travel insurance. I also understand that the Fellowship has made short term international travel insurance options available to me for purchase. The purchase of these services will be at the expense of each participant. I agree to be liable for any expenses that are incurred, including but not limited to early return expenses, uninsured medical expenses, medical expenses not covered by the purchased insurance and emergency evacuation.

Place your initials here:(*)
Please let us know your name.

I understand that traveling, living, and working abroad may present health risks. I also agree to take necessary precautions before and while traveling, including but not limited to appropriate inoculations and vaccinations. I acknowledge that it is my responsibility to determine which inoculations and vaccinations are required and that I have received all such required treatments.

Place your initials here:(*)
Please let us know your name.

I, for and in consideration of being permitted to participate in the mission of the Fellowship as a short term (volunteer) worker, do hereby acknowledge, hereby waive, release and forever discharge the Fellowship, of and from all manner of actions, causes of action, suits, debts, covenants, contracts, agreements, promises, claims and demands whatsoever, which I have, or which my personal representative, successor, heir or assign, can or may have, against said Fellowship, by reason of or related in any way to my participation in the mission sponsored by the Fellowship.

Place your initials here:(*)
Please let us know your name.

I agree to indemnify the Fellowship from all liabilities arising in favor of third parties resulting from my conduct while serving as a short term worker on a mission experience, preparing for a mission experience, or traveling to and from a mission destination. I also waive any right to assert any claim against the Fellowship or its agents with respect to work performed or any injury, illness or loss which I or any minor child or other person who is dependent upon me may sustain in the course of, or which arises out of, such short term work or such accompaniment. I waive any such claim both for myself and for any such minor child or other dependent person.

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I hereby grant the Fellowship permission to use, reproduce, and/or distribute photographs, films, video, and sound recordings of me or my child without compensation or approval, for use in materials created for purposes of promoting the activities of the Fellowship, including the internet.

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Please let us know your name.

In conclusion, I understand that the Cooperative Baptist Fellowship and its associates do not assume any responsibility for loss of property, damage to the same, personal harm, or illness that may come; and I, for myself, my heirs, executors, administrators, distributees, and assigns, in consideration of my admission to short term service and other good and valuable considerations, do hereby absolve said Cooperative Baptist Fellowship and hold said institution and its associates harmless from any claim or demand which I or they might conceivably assert upon the basis of foregoing by the submission of this document. I also understand that a criminal background check will be required and performed for short term service consideration. All incurred fees will be the responsibility of the applicant.

Place your initials here:(*)
Please let us know your name.

Children/Youth Safety: As a disaster response volunteer, you may interact with children and youth. We are concerned about the safety and well-being of all children and youth.

Do you plan to work specifically with children or youth during your service?(*)
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Date of Birth(*)
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Guardian for Applicants Under 18 Years of Age
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By checking the 'I agree' box and entering my full name below I recognize that this is equivalent to my legal signature where I attest that I am the legal guardian of the person named and she/he has my permission to serve with the Cooperative Baptist Fellowship.

Full Name
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Date
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Guardian Email Address
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Street Address(*)
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City(*)
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State(*)
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Zip Code
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