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Disaster Response Volunteer Application
Thank you for your interest in serving with CBF Disaster Response. This application will provide information about you, your interests and availability for service, and a release waiver required of all individuals serving with CBF. If you are a team leader, please make sure that each member of your team also completes this application before your time of service.
Type of Application
*
Team Leader
Team Member
Independent Volunteer
Name
*
First
Last
Preferred Name
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
*
Email
*
Birthdate
Name of Organization
Organization Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Emergency Contact Name
First
Last
Emergency Contact Phone
When are you available to serve?
Where are you interested in serving?
*
Choose one
Bremen, Kentucky
Skills
Health or Mobility Issues
Ways to Engage
Clean-up / Recovery
Food Preparation
Home Repairs
Chainsaw / Debris Work
Mud Outs
Administrative Assistance
Work Group Coordination
Skilled Contractor
Spiritual Care
Wherever I am needed
Please indicate desired ways to engage in a disaster response ministry
Supplemental Insurance
I have read the "Supplemental Insurance" information (found on the CBF Disaster Response page) and understand that I am encouraged to purchase this type of insurance if my insurance does not cover where I am going or what I am doing.
Photo (upload a picture)
Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.
Release Waiver
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.
SECTION 1
I hereby request permission to assist as a short term (volunteer) worker, in the charitable and religious work of Disaster Response 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:
Initial
*
SECTION 2
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. Given the risk of being infected or sharing infections of COVID-19, by volunteering during this pandemic, I understand these risks and agree to comply with the
Guidelines for CBF Disaster Response Volunteers During the COVID-19 Pandemic.
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 hereby request, I agree that I shall perform such work at my own risk. Place your initials here:
Initial
*
SECTION 3
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:
Initial
*
SECTION 4
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:
Initial
*
SECTION 5
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:
Initial
*
SECTION 6
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. Place your initials here:
Initial
*
SECTION 7
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. Place your initials here:
Initial
*
SECTION 8
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:
Initial
*
Participant Agreement
*
I agree
Signature
*
By typing my name into this field, I am confirming that the above information is accurate.
Signature Date
*
Witness Name
First
Last
Witness Agreement
I agree
Witness Email
Witness Signature Date
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