Welcome to The Rebuilding Our Community Dear Group Leader: Thank you for planning a volunteer team to work with The (Rebuilding Our Community). We look forward to working with you to rebuild and repair homes in Southern Indiana that were damaged by tornadoes on March 2, 2012. The is established for affiliated volunteer groups. Thank you for your understanding as The is structured to accommodate disaster experienced volunteer groups not individuals. The is a volunteer camp, all work is provided by Henryville Community Church (HCC) and/or the March2Recovery Long Term Recovery Committee. The staff will assist you when you arrive with setting up your work assignments through HCC. If your team has a worksite already designated, please let us know in advance along with site info and the organization providing that work. We hope your week is filled with meaningful work and that you have the opportunity to grow closer to Christ and experience the beautiful grounds of Country Lake Christian Retreat. Please find the attached camp rules, skills list and various release forms. Please feel free to contact us with any questions. We look forward to having your team at The! See ya soon! The Staff info@volunteersroc.org 574-231-7019 812-565-CAMP (2267)
Welcome to The Important Information Volunteer work teams will be housed at Country Lake Christian Retreat in Underwood, Indiana. This retreat provides housing and meals for your week-long trip and is located just a few minutes north of Henryville, Indiana which was heavily damaged by the tornadoes. The is a program of Country Lake Christian Retreat, INVOAD and Hope Crisis Response Network. During your stay, we ask that you please keep within the designated camp area at the. A host will meet your team and provide an opening orientation when you arrive at camp. Volunteer teams can check in Sunday evenings from 6-8 p.m. Groups will need to clean up and leave camp on Friday morning. The operates in cooperation with Country Lake Christian Retreat and we ask your cooperation in following these guidelines. Volunteer groups are also asked to remain separate from the regular summer camp children and teen activities. Camp rate is $75.00 per person, per week. This includes lodging, meals, and a T-shirt. When reserving your trip, you will need to make a $100.00 non-refundable deposit to book your group. The balance will be due 10 days prior to your arrival with your $100.00 being applied to your balance due. Please make checks payable to: Country Lake Christian Retreat The C/O Country Lake Christian Retreat 815 Country Lake Rd. Underwood, IN 47177 The is dormitory housing with bunk beds and more than one group may be staying in the same dorm. If your group has youth volunteers, we will not mix your group with other adult group housing. There is an age restriction on this project. No children under the age of 12 are permitted and any child under the age of 14 must be accompanied by an adult. Each group is required to provide volunteers to help with the kitchen each day during your stay. Breakfast and supper will be provided at camp and volunteers will have the opportunity to pack a sack lunch each day to eat at the worksite. Kitchen volunteers will be assisting with preparing and serving meals. All volunteers are expected to help clean and maintain common areas during your stay. We look forward to having your team at The! See ya soon! The Staff info@volunteersroc.org 574-231-7019 812-565-CAMP (2267)
VolunteersRoc.org Packet Contents 1. Volunteer Group Intake Form Group leader please complete and submit to reserve your team dates and beds 2. Individual Release of Liability Form - Adult Every group member must complete this form. 3. Medical InformaHon for Individual Volunteers Every group member must complete 4. Minor Volunteer Release Form For any volunteer under 18, must include parent or guardian signature 5. Medical Release for Minors A medical treatment release for any minor volunteer 6. House Rules Guidelines for our volunteers while on working with Volunteers Roc 7. T- shirt order form Size and number of t- shirts included with weekly cost. AddiHonal available as well 8. Teams skills check list Group leaders must submit copies of liability releases, medical informahon, and team skills at least ten days prior to your arrival.
Volunteer Group Intake Form Date / / Completed by Group Name Address Phone ( ) Email Contact Name Address Home Phone ( ) Work Phone ( ) Trip Details (First Choice) (Second Choice) Date / / Date / / ConCirmed on / / ConCirmed By / / # Male Adults # Male Youth # Female Adults # Female Youth Group Total Departure Date / / Last Work Date / / Volunteer Packet Sent / / Volunteer Packet Returned / / As much as we encourage the family unit this project has an age restriction. At this time we cannot house anyone under the age of 12 years old. A 1-1 ratio is required for all children under the age of 14.
Individual Release of Liability Form (Rebuilding our Community) Please read before signing, as this constitutes the agreement as a volunteer and the understanding of your working relationship as a volunteer with The. I acknowledge and state the following: I have chosen to travel to Southern Indiana to perform cleanup /construction work designed to repair damaged homes. I understand that this work entails a risk of physical injury and often involves hard physical labor, heavy lifting, and other strenuous activity, and that some activities may take place on ladders. I certify that I am in good health and physically able to perform this type of work. I understand that I am engaging in this project at my own risk. I assume all risk and responsibility as well as related costs and expenses for any damage or injury to my property or any personal injury, which I may sustain while involved in this project. I understand that The provides accommodations, I also understand that they are not responsible or liable for my personal effects and property and that they will not provide lock up or security for any items. I will hold them harmless in the event of theft, or for loss resulting from any source or cause. I further understand that I am to abide by whatever rules and regulations may be in effect for the accommodations at the time. I understand the need for concidentiality, and will not discuss, photograph or otherwise disclose identifying information about the occupants of the house I am working in without prior permission from and the family. This includes any reference to names, addresses, or other identiciable information. By my signature, for myself, my estate, and my heirs, I release, discharge, indemnify and forever hold, HCRN and Country Lake Christian Retreat and any other related Disaster Response Agency, together with their ofcicers, agents, servants and employee, harmless from any and all causes of action arising from my participation in this project, including travel or lodging associated therewith, or any damages which may be caused by their own negligence. Emergency Contact: Home ( ) Cell ( ) Work ( ) / / Print Name Signature Date
Medical Information for Individual Volunteers (Rebuilding Our Community) NAME Blood Type Prescriptions currently being taken: Name dosage Frequency Name dosage Frequency Name dosage Frequency Name dosage Frequency Allergies Medications dosage Frequency Name of contact person at home Relationship Street Address City State Zip Home Phone Cell Phone Health Insurance Company Policy Number (Attach copy of Insurance Card) Physical Limitations or issues: I am a diabetic Yes No I have a history of seizures Yes No Provide helpful health information I consider myself healthy enough to fulcill my responsibilities on this volunteer trip Yes No Signature of Volunteer Date / / This form will stay with your Team Leader on all projects.
(REBUILDING OUR COMMUNITY) MINOR VOLUNTEER RELEASE FORM First Name: Last Name: Address: City: State: Zip Email: Home Phone: Cell Phone: Emergency Contact Name Phone # I hereby release, indemnify and hold harmless The, HCRN and Country Lake Christian Retreat from any and all liability for any injury I may suffer (including any injury caused by negligence). I likewise hold harmless from liability any person transporting me to or from any or CLCR activities. I also give The or CLCR permission to use any video or photo s take of me on this project for promotional use only. Signature: Date: PARENTAL CONSENT/RELEASE - If the individual is a minor (under 18 years of age), the following should be signed by a parent or legal guardian. I hereby consent and agree, individually and as a parent or legal guardian of to all the terms and provisions above. Name (please print): Relationship to minor: Address: City: State: Zip: Signature: Date:
Medical Release Form for Minors (REBUILDING OUR COMMUNITY) Minor s Name Date / / Date of Birth / / Insurance Company Policy # Include copy of Insurance Card Emergency Contacts Name: Relationship Address City St Zip Home Phone ( ) Work Phone ( ) Cell ( ) Permission to give Aspirin Yes No Permission to give Tylenol Yes No List Allergies Medication(s) Dosage Frequency Describe any medical conditions or limitations Team Leader s Name Trip Destination: Southern Indiana Parent or Guardian Authorization I, authorize to consent to any necessary examination, anesthetic, medical diagnosis, surgery, or treatment and/or hospital care rendered to the minor under the advice of any physician or surgeon licensed to practice medicine by the state in which they practice, during the duration of the trip identicied above. Signature of Date / / This form is to be kept with your Team Leaders on all projects.
(Rebuilding Our Community) ***HOUSE RULES*** MEAL TIMES: Breakfast Lunch Dinner 7:00 a.m. 12:00 noon or on-site 6:00 p.m. QUIET TIME: 10:00 p.m. Sunday through Thursday LIGHTS OUT: 11:00 p.m. Sunday through Thursday THE CAMP IS CLOSED FROM FRIDAY MID-DAY UNTIL SUNDAY AT 6PM with the exception of extended stay volunteers. The camp does not host on the weekends. Work can and will be provided on Saturdays as one day projects. Thank you in advance for your understanding as Country Lake has other events that take place during these times. PHONE CALLS: Personal calls must be made by phone cards or collect calls. Computer access or Wi-Fi is not available at this time, but is coming soon. Devotions are every morning after breakfast. We would ask that your group be prepared to lead devotional time. There will be a Bible Study on Wednesday evening at 7:00. During your week at the For safety, it is important that proper personal protection equipment be worn on all job sites including footwear and appropriate clothing at all times. If you use chain saws you are required to wear chaps, NO EXCEPTIONS! - Modest dress at camp is appreciated, short sleeves and appropriate shorts are acceptable. - Clean up your work site after work each day. - Keep your personal space neat and clean. - In living together, be sensitive to your fellow volunteers. - The use of tobacco, alcohol and non-medicinal drugs is not acceptable at camp or on project sites. - Meals are provided daily and we request that you notify the camp director if you will not be joining us for any certain meals. - We ask that you remember that we are guest of Country Lake and that they have other events on the grounds. Please keep to the area as to not disrupt other events. - Please do not drive on the grass. - Think twice about personal jokes. Think about the GOLDEN RULE first. - You are a representative of Jesus, the Church and The. - Let your conversation and behavior fit the role of a volunteer to help people in need in the name of Christ. - Most of all to remember this week is not about you.
(Rebuilding Our Community) T- Shirt Order Form Name of Group Date of Arrival Contact Name Phone Shirt Size Small Medium Large XL XXL Additional Shirts and Hats can be purchased for $10.00 each. Please make checks payable to Country Lake Christian Retreat. Shirt Size Number $ 10.00 Total Small Medium Large XL XXL Hats $ 10.00 Total
TEAM SKILLS CHECKLIST, Week of Monday, / / Page of Church/Organization: City, State: Please list ALL church/organization members coming to Ranch Camp during the week written above. For those members having one or more special skills listed, please enter the number of years of experience in each field. If the person has a current, active license in any field, please underline the number in that field. LAST NAME FIRST NAME CONTACT NO. Framing Finish Electric Plumb. Masonry Drywall Painting Handy Mech. Siding 1. ( ) 2. ( ) 3. ( ) 4. ( ) 5. ( ) 6. ( ) 7. ( ) 8. ( ) 9. ( ) 10. ( ) 11. ( ) 12. ( ) 13. ( ) 14. ( ) 15. ( ) 16. ( ) 17. ( ) 18. ( ) 19. ( ) 20. ( ) Please complete and return to Camp. We will then forward the skills list to our building partner.