OPC Florence Disaster Response Volunteer Application Form
Email address *
Please specify the dates you are available to serve. *
Required
Applicant Information
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email *
Your answer
Cell Phone (xxx-xxx-xxxx) *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
Church or Group Information
Church/Group Name (if applicable) *
Your answer
Name of group leader (if applicable) *
Your answer
Phone number of group leader (if applicable) *
Your answer
Emergency Contact Information
Name *
Your answer
Relationship *
Your answer
Phone (xxx-xxx-xxxx) *
Your answer
Email *
Your answer
Second Emergency Contact Information
Name
Your answer
Relationship
Your answer
Phone (xxx-xxx-xxxx)
Your answer
Email
Your answer
Health Information
Are you currently in good health? *
Date of last Tetanus shot? *
Your answer
We strongly urge you to update your tetanus shot.
If injury occurs and you haven't had a tetanus shot, you will need one within 24 hours. If your tetanus shot has recently expired and injury occurs, you will need one within 48 hours.
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 (write none if none) *
Your answer
List dietary restrictions *
Simply write "none" if there are none
Your answer
Is there anything else we should know about your health?
Your answer
Do you have current medical coverage? *
Name and Phone Number of Insurance Company (if applicable)
Your answer
Name and Phone Number of Primary Doctor
Your answer
Availability Information
Planned arrival date
MM
/
DD
/
YYYY
Planned departure date
MM
/
DD
/
YYYY
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 *
Drywall Hanging *
Drywall Finishing *
Flooring *
Electrical *
Plumbing *
Heating and AC *
Preferred type of work
Tools and Supplies you can provide while volunteering
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 the affected areas 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
While reasonable efforts will be made to aid volunteers while working in the affected area, please know that accommodations and meals cannot be guaranteed. We encourage volunteers to make arrangements for their own provisions as much as is reasonably possible. We thank you for your servant attitude in ministering to the affected families.
If traveling from outside of the affected area, please affirm that you understand that you are responsible to pay your way to and from the area and have your own transportation while in the area. *
Please affirm that you understand that you are responsible for all of your meals 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 Florence Disaster Relief Volunteer Coordinator
Maribeth Campbell
florencevolunteers@opc.org
512-791-6096
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms