Volunteer

Fee Schedule

Short term Volunteer
All fees cover food, lodging, and in-country transportation.
Airfare to the DR and back is the responsibility of each volunteer.
One week $700.00
Two weeks $1100.00
Three weeks $1500.00
One month $1800.00
Two months $2800.00
Three months $3500.00
Early Sign up
If deposit is postmarked 90 days prior to trip $100.00 credit
Group scholarships are available of groups of 20 plus.

Volunteer Signup Form// //


APPLICATION FOR  DOMINICAN OUTREACH VOLUNTEER TRIPS

PLEASE RETURN APPLICATION AND DEPOSIT TO:
Dominican Outreach (809) 257-7246  Email:  <dominicanoutreach@yahoo.com>

Name:______________________________________________________________________________

Address:____________________________________________________________________________

City:_____________________________________State:______________________Zip:_____________

Phone_(____)_______________________________Email:____________________________________

Age:_______________Height:________________Weight_______________

Parent’s or spouse’s name:_____________________________________________________________
Note:  All participants under 18 must have signed parental permission slip and notarized statement from both parents or guardians for permission to travel out of the country.

Application for trip to which city:_________________________________________________________
Note:  There is a $100 late fee after published deadlines.  For medical reasons for cancellations deposits will be returned in full.

What are the primary reasons you are applying to travel on this trip?

Are you aware that travel to some third world or developing countries involves some risk, such as health, travel and emotional stress?

Do you have health insurance that would cover you in case of an out of country sickness or accident?

Do you have any physical, mental, or other problems that might affect your travel in a third world or developing country?  (If yes, explain)

Do you have a current, valid American passport?_____________Number:_______________________

Expiration date:__________________________Issue date:____________________________________

Location of issuance:__________________________________________________________________

Do you anticipate any problems getting the required finances for the trip?  If yes, explain:

Do you agree by your signature below to abide by the expectations and conduct of Dominican Outreach trips?______________( no sexual activity between unmarried participants, obey curfew guidelines; proper dress, other defined guidelines by the travel leader)

Do you understand that participants who disobey these guidelines may be sent home at participant’s expense?________________

Signature of applicant_________________________________________Date_____________________

RELEASE OF LIABILITY AND PARENT PERMISSION FORM
Dominican Outreach
(Required for all trips)

Whereas, the undersigned participant wishes to be accepted for participation in one or more of the activities listed above which is organized by Dominican Outreach of Ridgefield, Wa. in allowing the applicant to participate in such activities or programs, the undersigned acknowledges that the activity does involve certain risks.  The activities are designed to allow the participants to broaden their understanding of various cultural values, socio-economic differences, ethnic and racial diversity, cultural appreciation, team building, character development, and/or enrichment opportunities.  These activities include those listed above, but are not limited to, and activities in a lower income neighborhood and mong poor people in the Dominican Republic.  I understand that participants are exposed to physical and psychological risk through elements of nature, travel by car, van, plane, walking or other conveyance, and direct contact with people from various backgrounds.  Risks may also include damage or loss of personal property.  I further understand that immediate medical treatment may be difficult or delayed, especially in foreign countries.

In consideration of the above, I have and hereby do assume all the above risks and any other ordinary risk incidental to the nature of the program, including risks which are not specifically foreseeable, and will hold harmless the indemnify Dominican Outreach, and its Board of Directors, employeees, agents, and or Associates from any and all liability.  The terms hereof, and my signature on this document shall serve as a release and assumption of risk, and shall bind my heirs, representatives, executors, administrators, successors and assigns for all members of my family, including any minors accompanying me. I also state that I am not under, and will not be under the influence of any non-prescribed chemical substance, including alcohol.  I also state that I will assume responsibility for any damage or loss to physical property or expenses incurred due to negligent or irresponsible behavior.  I understand that my participation in this Dominican Outreach program or activity is entirely VOLUNTARY.

My signature also gives my permission and accepts financial responsibility, aswell, for first aid treatment and/or medical attention if needed.  I also give my permission for photographing of myself or my child during the activities and use of those pictures or video by Dominican Outreach.

_____________________________________    __________________  _____________________________________
PARTICIPANT SIGNATURE                            DATE                           WITNESS

______________________________________   __________________  ____________________________________
PARENT/GUARDIAN SIGNATURE FOR        DATE                           WITNESS
ANY PARTICIPANT UNDER AGE 18

Please print legibly:

Participant name:___________________________________________________________________Age_________

Street address:__________________________________________________________________________________

City:_______________________________________________State:_______________________Zip_____________

Phone:_(_______)____________________________________

In case of emergency, please contact:_______________________________________________________________

Phone:(______)_____________________________Relationship to participant_______________________________

Sponsoring group, church, etc., if any:________________________________________________________________

Group leader:___________________________________________________________________________________

List below any physical, mental or emotional problems this participant has.  Include any medications to which he/she is allergic:

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

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