Volunteer

Volunteer Information

Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What are you interested in volunteering for?*

What internship position are you applying for?*

Contact Information

Email*

Phone*

Preferred Method of Contact

Phone
Email

Emergency Contact Name*

Emergency Contact Primary Phone*

Emergency Contact Alternate Phone

References

List*

Name	Phone	Relationship

Please add between 3-5 references

Background Information

Please list relevant current and former volunteer experiences and dates you were involved*

Please list any skills/hobbies/interest you are willing to share through your volunteering.

Education and Availability

Education*

High School/ College	Degree Received	Major

Please list your weekly availability for the internship position. List the hours and days your are available throughout the week.*

Additional Info

Do you have a driver's license and a vehicle you are willing to use during your internship hours?*

If you have a digital portfolio of your graphic design work, please include the link below. If you do not have a website, please send your relevant work to bethany@dreamhaiti.org.

Please name the church/group/organization you are affiliated with, if any

How did you find out about Dream Haiti?*

Vision and Mission

Understanding and believing in the vision and mission of Dream Haiti is an important part of being a CA. In your own words, what would you say is the vision and mission of Dream Haiti?*

Introduce Yourself

Please explain in 100-500 words why you would like to be a volunteer with Dream Haiti. What inspires you to serve? Why did you choose Dream Haiti in particular? What do you hope to bring to your volunteer experience and take with you from your time with us?*

Please explain in 200-500 words why you would like to be a Community Ambassador with Dream Haiti. What inspires you to serve with Dream Haiti? What do you hope to bring to your volunteer experience and take with you from your time with us?*

Volunteer Agreement

No Employment Relationship. We highly value volunteers and the support they provide to our organization. However, a volunteer is not employed or entitled to compensation, benefits or insurance of any kind by Dream Haiti, INC.
Volunteer Responsibilities. The volunteer agrees to a) assist the organization in accordance to their assigned and agreed upon duties, b) follow the policies set forth by Dream Haiti and act in a professional and appropriate manor when representing Dream Haiti,
Dream Haiti’s Responsibilities. Dream Haiti agrees to 1) provide expectations, training and resources when necessary, and support to the best of its ability, 2) treat volunteers with respect, appreciation and consideration
Term of the Agreement. This volunteer agreement may be terminated by either party at any time for any reason and without notice.

*

I agree to the terms above

Missions Trip Information

Do you have a relationship with Jesus Christ?*

Yes
Somewhat
No

Describe your idea of faith and/ or your relationship with Jesus Christ.

How flexible of a person are you? (10 being very flexible in all situations)*

How would you react towards someone who thinks differently than you about something that is important to you?*

Describe any experience you have had outside of the country*

What are you good at doing?*

Please list any allergies and/ or medical conditions you may have, as well as any medications you will need to take while in Haiti. (If none, please write, "N/A".)*

Liability Waver*

I have read and understand the liability waver below

I recognize that there are risks involved in participating in the mission trip and hereby assume all risk of injury, harm, damage, or death in connection with my participation in it. I understand and agree that neither Dream Haiti nor its trustees, officers, directors, employees, agents or representatives may be held liable in any way for any injury, harm, damage, or death that may occur to me as a result of my participation in this mission trip and hereby release Dream Haiti its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death, which may occur while I am participating in the mission trip. I authorize Dream Haiti through its trustees, officers, directors, employees, agents or representatives to render or obtain such emergency medical care or treatment for me as may be necessary should any injury, harm or accident occur to me while participating in the mission trip. I understand and acknowledge that Dream Haiti does not provide health or medical insurance in connection with the mission trip and I agree that I will be financially responsible for any bills incurred as a result of medical treatment, including emergency medical treatment and/or transportation to a medical facility, in connection with my participation in the mission trip.

Please sign your name here to indicate that you have read and agree to abide by the liability waver above.*