Houston OPC Disaster Response Volunteer Application Form
Applicant
Name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
Email *
Your answer
Mailing address *
Your answer
Phone *
Your answer
Church or Group You Are Coming With
Church or Group Name *
Your answer
Name of pastor of your church or leader of your group *
Your answer
Email or phone number of pastor or leader *
Your answer
Emergency Contact
Name *
Your answer
Relationship *
Your answer
Phone *
Your answer
Email *
Your answer
Health
Are you currently in good health? *
Have you had a Tetanus shot within the last ten years? *
List allergies (write none if none) *
Your answer
List Medications (write none if none) *
Your answer
List Disabilities (write none if none) *
Your answer
Explain any major surgeries or illnesses in the last two years?
Your answer
List dietary restrictions *
Your answer
Is there anything else we should know about your health?
Your answer
Do you have current medical coverage? *
Availability
Please specify the dates you are available to serve. *
Your answer
Any previous volunteer experience? If so, please briefly describe. *
Your answer
Construction Experience
Rate yourself: 0 = No experience and 5 = expert
Rough Carpentry *
Finish Carpentry *
Plaster *
Flooring *
Electrical *
Plumbing *
Heating and AC *
Other
Your answer
Non-skilled labor (For example: general cleaning and demolition, painting, cooking, administration/communication) *
Hazard/Liability Agreement
Do you acknowledge that you will be entering a disaster zone with possible risks, and considering said risks, do you agree to abide by any precautions prescribed by those in charge of the project? *
Do you acknowledge the possible hazards of volunteering and agree to not hold the OPC, or any pastors, leaders or churches in Houston liable if you are injured in any way? *
Expectations
The circumstances of disaster response work mean that it is hard to always predict the type of work that one will do. At times, the team may get delayed and it may seem to you that precious time is being wasted. It is important that you are willing to be patient with the leaders and are willing to wait in the Lord on His promises that all will work out to the good of His children. *
SOCIAL MEDIA: Please affirm that you understand this is not a time to post photos to social media. There will be no pictures or information posted on social media or the internet that include the following: identification of the address of the structure; homeowners receiving assistance from us; information concerning addresses or names of homeowners. *
Costs
If traveling from outside of Houston, please affirm that you understand that you are responsible to pay your way to and from Houston and for most of your food while serving. *
Housing
Are you in need of housing? *
If so, how many in your party are in need of housing?
Your answer
Do you have a motor home, RV, etc? *
If so, will you need parking for such a vehicle?
Thank you!
If you have questions, please feel free to email or call OPC Houston Disaster Relief Volunteer Coordinator
Peggy Sumpter
peggy.sumpter@opc.org
346-205-1801
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