CONTACT INFORMATION:
Your Photograph Needs to Be Attached to the Right:

Date:_____________________________________________

Name:____________________________________________

Name of Team Leader: _______________________________

Address:__________________________________________

City:_____________________________________________

State:____________________________________________

Zip Code:_________________________________________

Home Phone:______________________________________

Mobile Phone:_____________________________________

Day Time Phone:___________________________________

Email Address:____________________________________

Number to receive faxes:____________________________

Date of birth:_____________________________________

Male / Female:____________________________________

Marital status:____________________________________

If married, spouse's name: _________________________

Background Information:

Previous volunteer mission service (Please check or fill in):

________________________________________________

________________________________________________

I have participated on a volunteer mission trip:

Stateside[ ]

Internationally[ ]

I have worked with peoples of cultures other than my own:

List:

1) ____________________________________________

2) ____________________________________________

I am reading about the culture and I am preparing to serve cross-culturally before I leave.

Yes       No

Education:

College Degree:__________________________________

Degree / Major:__________________________________

Life Skills:_______________________________________

_______________________________________________

_______________________________________________

Employment:

Employed? Yes No

Employer:_______________________________________

Position:________________________________________

Church History:

Attend Church?YesNo

Church Name: ____________________________________

Church Mailing address: ____________________________

Pastor:_________________________________________

Denomination:___________________________________

ESL Certification:   No   If Yes, what year? _____________

Field Placement: CBF/Baptist Builders Initiative in New Orleans

Field Coordinator: Reid Doster (985) 222-6900

Assignment: Assisting churches and pastors in rebuilding

Proposed Dates On the Field:________________________

Total Number of People on Team / Family: _____________

If you are an intergenerational team or a family team please list the names of those members 17 years and younger:

______________________________________________

______________________________________________

______________________________________________

(If more space needed, please attach a separate list.)

RELEASE FROM LIABILITY
Finally, in accepting this assignment I hereby express my understanding 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 volunteer service and other good and valuable considerations, do hereby absolve said Cooperative Baptist Fellowship and its associates and hold them harmless from any claim or demand which I or they might conceivably assert upon the basis of the foregoing.

Signature:_______________________________________

Date:___________________________________________

Parent or Guardian Signature (for volunteers 17 years and under):

_______________________________________________

EMERGENCY CONTACT INFORMATION

Name #1:________________________________________

Relationship:_____________________________________

Phone(s):_______________________________________

Email:__________________________________________

Name #2:_______________________________________

Relationship:_____________________________________

Phone(s):_______________________________________

Email:__________________________________________

Some opportunities will require a background check.

If you would like documentation of your volunteer service with CBF for tax purposes please let us know. This will be done on an individual basis and by request only.    Yes   No

Do we have your permission to share contact and service information with your State / Regional CBF office?   Yes  No

Thank you! Please make sure you have filled or checked every box that is applicable to you! Again please call or email us with any questions or concerns.

PLEASE RETURN TO:CBF Global Missions Office
1000 E. Beltline Road, Suite 105, Carrollton, TX 75006
Phones:  972-242-5566 or 800-782- 2451 (toll free)
Fax: 972- 389- 9857
Email: volunteer@thefellowship.info

WHAT TO BRING
You will need to bring a lightweight cot or air mattress and light-weight sleeping bag, as well as toilet articles, towels and cool clothing, mosquito repellant, sun screen, bottled water, hat, one first aid kit per team and work gloves for everyone. Your team will do well to have available several N90 filtration masks, capable of filtering out mold. Fortunately, many of the structures we will be restoring have already been gutted and disinfected. If your team leader has a GPS unit with street maps, this might also prove beneficial.

TOOLS AND MATERIALS
We will provide tools and materials, unless you prefer to use you own tools.

LENGTH OF STAY
Our experence is that four intense work days are maximum. Then, people need a break. Generally, groups arrive on Sunday evening, work hard Monday through Thursday and return home on Friday. Of course, you can generally set your own schedule.

MEALS
At this point, you can assume that you will be responsible for supplying and preparing you're your meals. Kitchen facilities are available. There are some exceptions to this, depending upon the worksite.

SIZE OF TEAMS
We have found it more effective for volunteer groups to organize themselves into teams of six or seven members each, with a designated leader, and do this before they arrive on the worksite. Larger groups can organize into teams of six or seven people each, again with designated captains. Various skills can be distributed evenly among the teams.

SKILL LEVELS
It will be most helpful, although not necessary, if your team has at least one person with experience in light construction work. Anyone who is physically capable of working will find a meaningful role to perform.

YOUTH UNDER 18 YEARS OF AGE
CBF Louisiana does accommodate volunteers under 18 years of age, so long as they remain under supervision by an adult. They do qualify for travel insurance described below.

TRAVEL INSURANCE
CBF requires all volunteers to obtain secondary insurance. This insurance can cover the whole length of time on the trip, including from the day you depart to the day you return to your home city. Insurance is secured through Adams & Associates International. Be sure to complete this process early in your preparation. It is recommended that the copies of your insurance papers be sent by fax (972.389.9857) or email (volunteer@thefellowship.info) the copies to the CBF Global Missions office in Dallas prior to departure. Originals of the secondary insurance papers and the check can be sent directly to Adams & Associates offices in South Carolina. Coverage also can be arranged by going to the Adams & Associates International website: www.aaintl.com  Click on the "Online Enrollment" button at the top of the screen.           

The USER Name is:  CBF
The Password is:     VOLUNTEER

Both the USA and International options are available AND CBF will be automatically notified of your enrollment. ID cards will be available "on-line" after your enrollment is submitted.

The importance of secondary insurance for US assignments is that it provides volunteers with:

1. Excess Accidental Insurance

2. Security of knowing that there is not an out of pocket expense for the volunteer if on a CBF volunteer mission trip

3. Accidental Insurance for specific volunteer missions up to $10,000 with a deductible of $50

In plain words, it gives extra coverage if there is an accident. If a volunteer does not have insurance, this becomes their primary insurance for US trips only. Contact Adams & Associates International if you are in need of a short-term USA primary medical coverage.

Note: USA related trip coverage plans do not cover medical evacuation.

NOTE:  $100 deductible for medical and property coverage for each occurrence.

Adams & Associates International
PO Box 5845Columbia, SC29250 – 5845
Tel: (803) 758-1400 Fax: (803) 252-1988
Email: aai@aaintl.com
Internet: www.aaintl.com

CBF LOUISIANA DISASTER RESPONSE COORDINATOR
Name: Reid Doster
Title: CBF Louisiana Disaster Response Coordinator
Cell: (985) 222-6900
Cell: (985) 778-6049
Fax: (985) 845-3206
Address: 406 Pine Street, Madisonville, LA 70447
Email: reid_doster@hotmail.com