Page 1 Haiti Medical & Orphanage Mission Volunteer Information Packet Fall 2017 Oasis Church of South Florida & H.A.N.A Missions missions@visitoasis.org
Page 2 Table of Contents Table of Contents...2 Application...3 Recommended Supply List...4 Do s & Don ts.....6 Trip Information & Cost...7 Consent and Release Form. 8 Emergency Contact Information. 11 Resources... 12 Itinerary.13
Page 3 Application Name: Date of Birth: Profession: Specialty: License number: Gender: Do you have a U.S. Passport? Y N Exp. Date: Passport Number: If you do not have a U.S. Passport please provide the country in which you do for travel insurance purposes: If you are not a U.S. Citizen please provide your Green Card number for travel insurance purposes: Your reason for volunteering: Signature: Date:
Page 4 Recommended Supply List Snacks o Protein bars o Powdered drink mix o Fruit gummies/candy o Trail mix Flashlight o Batteries Personal fan o Batteries Toiletries o Soap Bar Liquid o Toothpaste o Toothbrush o Washcloth o Shampoo/Conditioner o Hand sanitizer o Baby wipes/wet wipes o Toilet paper Personal medication Towel Pillow Pillow Case Blanket
Page 5 Recommended Supply List Cont d Mirror Sunblock Fanny Pack Hat (no logos) Sunglasses (no logos) Protective footwear (no logos) o Work Boots o Sneakers Flip flops Raincoat/Jacket Mosquito Prevention o Bracelet Repellant o Spray Repellant o Mosquito Net Loose fitting breathable clothing (no logos & nondescript) o Tshirts o Shorts/Pants Passport o Original o Copy Bring Cash o $10 will be needed to enter the country *All medical professionals please be sure to bring your own stethoscopes and blood pressure cuffs
Page 6 *All travelers are required to bring ONE personal bag and ONE carry on bag ONLY * Provide a copy of important documentation you are carrying to a friend or family member Suggested Do s & Don ts While in Haiti DO: Drink bottled water Observe your surroundings Keep passport secured Be kind and courteous Brush teeth with water bottle water DO NOT: Drink tap water/ice/shower water Come in contact with wild life/animals Eat raw or undercooked meat Bring attention to yourself
Page 7 Trip Information & Cost The Oasis Church of South Florida in partnership with the Haitian American Nurses Association of Florida is organizing this medical mission. This Fall s Medical & Orphanage mission trip will take place in St. Marc & Pierre Payen, Haiti, where we will be seeing/treating children and adults. The total cost of the trip is $799.00 due by August 6 th. A $100 Non-Refundable Deposit is needed to hold your spot on the trip due by July 9 th. This may be paid via: Cash, Check (written to: Oasis Church) or Credit Card. Any payment method will receive a confirmation. For more information please see our Resources page on page 12 and our Itinerary on page 13.
Page 8 Consent and Release Form I do hereby release and hold harmless Oasis Church of South Florida from and against any and all liabilities to the undersigned, his/her dependents, assigns, personal representatives, heirs and next of kin for any and all damages, expenses (including attorney fees), claims, judgments, actions or causes of action as a result of any loss or injury to the person or property, including death, which (name of participant) may sustain or suffer during or arising out of activities of the above described event and during transportation to and from such event whether caused by negligence of the Oasis Church, of persons acting on its behalf or otherwise, and any other releases. I release from liability all representatives of the Oasis Church of South Florida, and the releases, for their acts performed and statements made, in good faith and without malice, in connection with evaluating my credentials and qualifications and further release all individuals and organizations who provide information, including otherwise privileged or confidential information, in good faith and without malice, concerning my professional competence and background.
Page 9 Consent and Release Form Cont d In full recognition and appreciation of the dangers and hazards involved in such activity, I do hereby agree to assume all risks and responsibilities surrounding my participation in this event, including but not limited to any and all foreseen, unforeseen, known, or unknown to my health, safety, or professional status. I verify that I have any and all professional licenses necessary to provide professional care and treatment and those licenses are valid, clean, and active (only for healthcare providers). I verify that I have no health conditions of which I am aware that would prevent me from providing services during the medical mission. I also verify that I am aware of any and all applicable travel requirements, restrictions, and warnings; have taken whatever precautions I deem necessary for my personal health and safety; and that I have in my possession valid travel documents and am otherwise authorized to travel out of the country and to provide aid services in Haiti.
Page 10 Consent and Release Form Cont d I acknowledge and agree that I am participating in this mission voluntarily and based upon a full and express assumption of all risks of loss, either to me personally or from claims of third parties; that I will not seek to recover from the releases for any harm to myself or to others for which I may be liable; and that to the extent I deem it appropriate I have though self-insurance, insurance, or otherwise, provided for protection against such risks. I further acknowledge that I have read and understand this release and voluntarily sign this document. I hereby state that all the information I provide on this application is true, complete, and accurate. Printed Name Profession (if applicable) License Number (if applicable) Signature Date
Page 11 Emergency Contact Information I (print name): authorize the staff of Oasis Church of South Florida to please contact the following person(s) in the event of an emergency: Name: Relationship: Address: Phone number: Name: Relationship: Address: Phone number: Signature: Date:
Page 12 Resources Jonathan Jimenez Missions Pastor 954-918-6614 missions@visitoasis.org Nicole Leon Missions Coordinator 954-873-8787 missions@visitoasis.org Amina Dubuisson H.A.N.A. Former President 305-389-9485 missions@visitoasis.org visitoasis.org/missions National Information for Vaccinations 888-499-7277 passporthealthusa.com Dade County Public Health Offices 888-498-7277 305-324-2400 dadehealth.org National Passport Information 877-487-2778 Rush My Passport Information 866-682-1505
Page 13 Thursday Aug. 31, 2017 Arrive to Oasis at 6:30am Departing from Miami at 10:49AM Arriving at Port-au-Prince, Haiti at 12:59PM Noon Visit Oasis Sponsored Orphanage Getting situated at Guest House Itinerary Day 1 Day 2 Friday Sept. 1, 2017 Medical Mission at Institution Jean Ulrick Moïse / Church Saturday Sept. 2, 2017 Medical Mission at Institution Jean Ulrick Moïse / Church Day 3 Day 4 Sunday Sept. 3, 2017 Free Day in Haiti to Enjoy (must stay in groups, not go alone) Monday Sept. 4, 2017 Arrive to PAP Airport at 11:30 AM Depart from Port-au- Prince, Haiti at 1:55 PM Arriving at Miami at 4:08 PM Day 5