Forms

 VOLUNTEER APPLICATION 

 Please print and mail in to: 

Assisting Better Living Everywhere, 3175 Custer Drive, suite 103, Lexington, KY 40517

OR

For Austin Chapter: 2900 Quinlan Park Road, suite 240/319, Austin, TX 78732

Welcome to ABLE!  We are excited that you decided to join our volunteer team.  ABLE’s Mission is: “To restore, by the grace of God, people’s spirit, confidence and belief in their own abilities by the help we provide.”  To assist others through ABLE’s projects requires commitment, strength of character and faith in the human capacity.  There are many ways in which to serve.  Besides building projects, we also welcome individuals to assist with health and hygiene needs, food preparation services and other specialty skills such as language, transportation, and public relations.  No specific skills are required except to have an adventurous spirit and a desire to help others.  Please join us. You will be rewarded greatly by the love, thankfulness, and appreciation of those you help.

The registration fee is ___________ and includes hotel accommodations, ground travel, food, water, evacuation insurance, team leader expenses and a donation for the mission project. Air travel, alcohol, any visa fees, medical expenses, personal items and souvenirs are not included and are personal responsibilities of each volunteer.

Please complete the following information and return to the address above with a deposit of $100.    Please make checks out to “ABLE”.

 

General Information:

 

Today’s Date:

 ______________________

Trip Name:

 ______________________

Trip Date:

 ______________________

Last Name:

 ______________________

First Name:

 ______________________

Home Address:

 ______________________

City:

 ______________________

State:

 ______________________

Zip Code:

 ______________________

Home Phone:

 ______________________

Mobile Phone:

 ______________________

 ______________________

 ______________________

Email Address:

 ______________________

Gender (M/F):

 ____

DOB:

 ___________

Citizenship:

______________________

Occupation:

 ______________________

Religion (optional)

 ______________________

Travelling With:

 ______________________

 

 

 

Passport Information:  (Must be valid for six months beyond your travel date.)

 

Please attach a copy of the picture page of your passport.

Name on Passport:

 ______________________

Jurisdiction:

 ______________________

Passport Number:

 ______________________

Expiration Date:

______________________

 

 

Skills: __________________________________________________________________

 _______________________________________________________________________

Check any skills, or area of interest you can bring to a team.

Construction**

Masonry

Electrical

First Aid/CPR

Data Processing

Medical Professional***

Painting

Food Service

Volunteer Mgt

Foreign Language

 ______________________

Proficiency (basic or proficient):

 ______________________

Foreign Language

 ______________________

Proficiency (basic or proficient):

 ______________________

Foreign Language

 ______________________

Proficiency (basic or proficient):

 ______________________

**Construction Experience [Examples: Framing, Brick, Plumbing, etc]

Proficiency[basic, semi, skilled, trade, licensed]

 ____________________________________________

 ______________________

***Medical ProfessionalMedical Type and Specialty

 ____________________________________________

 

Medical Information:

 

Personal Physical Fitness

Excellent

 ___

Good

 ___

Fair

 ___

Poor

___

Physical limitations, handicaps, etc.(please list)

 ____________________________________________

Allergies: medications, seasonal, food(please list)

 ____________________________________________

Current medications(please list)

 ____________________________________________

Special Dietary Requirements(please list)

 ____________________________________________

Reminder: Be sure to pack your medication in your “carry on” bag!

Emergency Contact:

 

Name:

 ______________________

Relationship:

 ______________________

Phone:

 ______________________

Email Address:

 ______________________

 

 

Tell us a little about yourself:

T-shirt size: Adult  S  M  L  XL (circle preference)

Preferred name to be called:______________________________________________________­­­___________

Family life: ______________________________________________________________________________

What I do for fun:_________________________________________________________________________

Hobbies/Sports:___________________________________________________________________________

Previous mission trips:______________________________________________________________________

Why I am interested in this mission trip and what I want to get out of it:_______________________________

________________________________________________________________________________________

________________________________________________________________________________________

What else should we know? _________________________________________________________________

Mail this application,  release waiver, $100 deposit and copy of passport to:

 

Assisting Better Living Everywhere                                                                                             

3175 Custer Drive, suite 103, Lexington, KY 40517

OR

Austin Chapter

2900 Quinlan Park Road, suite 240/319, Austin, TX 78732

 

 

 

RELEASE AND INDEMNITY AGREEMENT

 

Name: ______________________________________Age:________________DOB:________________

Address: ______________________________________City:___________________State____________

Phone:________________________________ Alternate Phone:_________________________________

I hereby release and agree to hold harmless and indemnify ABLE, INC., its agents, employees, trustees, members, sponsors, and representatives, from all claims and causes of action whatsoever caused in any way from my attendance at and participation in, directly or indirectly, the 2014 trip to Uganda including travel to and from the work sight and all activities, during such trip, and including all claims for personal injury and death and damage to property.

In the event of a medical emergency, I understand that every effort will be made to contact family members.  But, in the event that they cannot be reached, I give my permission to the leadership of ABLE to solicit medical care, including anesthesia, in my best interest.  I further release ABLE, Inc., its officers and staff from any liability associated with such medical emergency.

Signature:_________________________________________ Date_______________________________

Emergency Contact Information: _________________________________________________________

Please list any allergies or other physical limitations that might require necessary medical attention.  (i.e. allergies to bee stings, foods)_____________________________________________________________

______________________________________________________________________________

If at any time during this trip, should you require medical attention, please list any special instructions that might be necessary in your treatment.___________________________________________________

______________________________________________________________________________

Please list any prescription medication that you are required to have in your possession while on trip.

____________________________________________________________________________________________________________________________________________________________

If you have medical insurance, please indicate the company name:_______________________________

Policy/ID number:__________________________________Phone Number:_______________________

Family Doctor_____________________________________Phone Number:_______________________

It is agreed by all and understood that this agreement is governed by the laws of the Commonwealth of Kentucky, the home of registration for Assisting Better Living Everywhere, INC.”.

 

Signature:_______________________________________  Date:________________________

Witness: ________________________________________  Date:________________________

To Complete the volunteer application online:  
Click here

 

 

 

Download the ABLE volunteer application PDF form to become a volunteer.

Don’t have the time? Donate to ABLE projects instead.

 

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