Hurricane Florence Volunteer Mission

First Name *

Last Name *

Date of Birth *

Volunteers must be at least 16 years old. Volunteers ages 16-18 must be accompanied by a parent or guardian.

Address *

Address

City

State/Province

Zip/Postal

Cell Phone Number *

E-mail Address *

Emergency Contact

Name *

Relation *

Phone Number *

Alternate Phone Number

Email Address *

Lodging and Dining

Your registration will include a double occupancy room. Please indicate your lodging preference below: *

I will stay in the group lodging. Please assign me a roommate.

I will stay in the group lodging. I am requesting a specific roommate.

I will arrange (and cover the cost of) my own housing. I understand that I will have to arrange my own daily transportation.

Requested Roommate Name: *

JVC will strive to meet the dietary needs of all participants. Please provide information about your dietary needs, including level of kashrut.

Do you require any other special accommodations? If so, please provide details.

Would you like to register an additional family member for this mission? *

Yes

No

Everyone you register must share your home address. Please direct other interested friends/relatives to register independently.

Additional Volunteer #1

First Name *

Last Name *

Date of Birth *

Volunteers must be at least 16 years old. Volunteers ages 16-18 must be accompanied by a parent or guardian.

Cell Phone Number *

E-mail Address *

Your registration will include a double occupancy room. Please indicate your lodging preference below: *

I will stay in the group lodging. Please assign me a roommate.

I will stay in the group lodging. I am requesting a specific roommate.

I will arrange (and cover the cost of) my own housing. I understand that I will have to arrange my own daily transportation.

Requested Roommate Name: *

JVC will strive to meet the dietary needs of all participants. Please provide information about your dietary needs, including level of kashrut.

Do you require any other special accommodations? If so, please provide details.

Would you like to register an additional family member for this mission? *

Yes

No

Everyone you register must share your home address. Please direct other interested friends/relatives to register independently.

Additional Volunteer #2

First Name *

Last Name *

Date of Birth *

Volunteers must be at least 16 years old. Volunteers ages 16-18 must be accompanied by a parent or guardian.

Cell Phone Number *

E-mail Address *

Your registration will include a double occupancy room. Please indicate your lodging preference below: *

I will stay in the group lodging. Please assign me a roommate.

I will stay in the group lodging. I am requesting a specific roommate.

I will arrange (and cover the cost of) my own housing. I understand that I will have to arrange my own daily transportation.

Requested Roommate Name: *

JVC will strive to meet the dietary needs of all participants. Please provide information about your dietary needs, including level of kashrut.

Do you require any other special accommodations? If so, please provide details.

Would you like to register an additional family member for this mission? *

Yes

No

Everyone you register must share your home address. Please direct other interested friends/relatives to register independently.

Additional Volunteer #3

First Name *

Last Name *

Date of Birth *

Volunteers must be at least 16 years old. Volunteers ages 16-18 must be accompanied by a parent or guardian.

Cell Phone Number *

E-mail Address *

Your registration will include a double occupancy room. Please indicate your lodging preference below: *

I will stay in the group lodging. Please assign me a roommate.

I will stay in the group lodging. I am requesting a specific roommate.

I will arrange (and cover the cost of) my own housing. I understand that I will have to arrange my own daily transportation.

Requested Roommate Name: *

JVC will strive to meet the dietary needs of all participants. Please provide information about your dietary needs, including level of kashrut.

Do you require any other special accommodations? If so, please provide details.

Agreements

I understand that I am responsible for booking my own flights in and out of Raleigh-Durham International Airport. In order to use the group's transportation, I understand that I will have to arrive in Raleigh-Durham by 4:30pm on Sunday, December 2 and depart from Raleigh-Durham no earlier than 7:00 pm on Wednesday December 5. My flight must be booked by November 12, 2018. (Flight recommendations will be provided to all registrants.)* *

I Agree

I release and hold harmless THE ASSOCIATED: Jewish Community Federation of Baltimore, its affiliates, officers, employees and agents from and against all claims, damages, liabilities, losses and expenses actually incurred, arising out of any personal injury or property damage resulting from participation in any activity. This release shall be binding on my family, heirs, executors, administrators, personal representatives and guardians. *

I Agree

For volunteers under age 18: I represent that I am the custodial parent or legal guardian of the above registered child(ren), and intend THE ASSOCIATED and its affiliates, officers, employees and agents rely on this representation.

I Agree

I understand that I will receive and be required to complete additional liability release and medical information forms from the Baptist General Assembly of Virginia, the local organizer contracted by JVC to facilitate this trip.

I Agree

I give my permission to have my photograph used by THE ASSOCIATED: Jewish Community Federation of Baltimore. My signature on this Photograph Release Form gives photography release rights to THE ASSOCIATED. This release pertains to print as well as electronic media, including brochures, advertisements, annual reports, the website and other materials used to promote ASSOCIATED and constituent agency programs to the community. *

I Agree

I Do Not Agree

Emergency Contact

Lodging and Dining

Additional Volunteer #1

Additional Volunteer #2

Additional Volunteer #3

Agreements

Contact Info