Information and Checklist Hurricane Florence Recovery Trip February 9-16, 2019 Important Dates: o Dec 2 – Participant Application Due

o Dec 23 – All forms and clearances + Initial $100 deposit payment due o Jan 27 – All funds due, Team Meeting All completed forms can be emailed to relief@crossroadsumc.org or turned into your campus office “Campus offices please return to North Fayette, Attn: Pat Roddy, Relief & Recovery.” Checklist:

● Participant Application*

● Medical Release*

● Mission Policy Agreement*

● Participant Liability Form*

● Individual Skills Survey*

● Confirmation and Signature*

● Deposit ($100)

● Safe Sanctuaries Clearances (applying as a volunteer is free)*

○ State Police Criminal Background Check (Act 34) ■ https://epatch.state.pa.us/TandCVolunteerAction.do?

○ Pennsylvania Child Abuse History Clearance (Childline, Act 33) ■ https://www.compass.state.pa.us/cwis/public/home

○ You will receive by email or paper mail your background check and child abuse history results, please submit a copy of these results. They should look like the examples below. Apply for these ASAP, it can take a few weeks to get your results.

*keep a copy for your records

Participant Application Hurricane Florence Recovery Trip February 9-16, 2019 Cost: $400 Deposit: $100 February 9-16, 2019 The mission trip team leader will not share information from the following forms except as required and related to the mission trip.

Name: ________________________________________ Phone: ___________________________

Mailing Address: ________________________________City, State, Zip: ______________________

Age: ________ Sex: ________ Email address: _________________________________________

Occupation: __________________________ Languages: _________________________________

Missions experience and location: _____________________________________________________

_______________________________________________________________________________

Crossroads Campus: __________________________________ T-shirt Size: ________________

Why do you wish to participate? (if more space is needed use separate page): _________________

________________________________________________________________________________

________________________________________________________________________________

Please indicate your state of physical and emotional health (the project and trip will include rigorous

activity and the hours may be long). Is there anything the team leader(s) should know regarding your

health (allergies, diet, etc.)?

________________________________________________________________________________

________________________________________________________________________________

Team members may be asked during a church service to give a 2-3 minute testimonial before or after

the project. Would you be comfortable doing this? _____Yes _____ No _____ Maybe I understand that team members must be cheerful, cooperative, flexible, and patient. I agree to cooperate with the team leader(s) concerning our life together, including daily assignments, food, lodging, and transportation and any other activities involving the team as a whole. I agree to stay with the team from the beginning to end of the trip (except as excused by the team leader), to abstain from the use of alcohol and tobacco while on the mission trip, and generally to behave in a Christian manner. Signature provided on “Confirmation and Signature Form”

Medical Release Hurricane Florence Recovery Trip February 9-16, 2019 I___________________________________ authorize _________________________________

(Crossroads participant) (another adult on trip) If I am unable to do so, to consent to any necessary examination, anesthetic, medical diagnosis, surgery treatment and/or hospital care rendered to me under the general supervision and on the advice of any physician or surgeon licensed to practice medicine by the state in which he/she practices, during the duration of the trip identified below. I further authorize the release of medical information from my personal medical records for the purpose of caring for me while on this trip, but I do not give permission for any other use or re-disclosure of this information.

Home Physician: __________________________________ Phone: __________________________

Medical Insurance Provider: _________________________ Phone: __________________________

Policy Number: ___________________________ Group Number:____________________________

Allergies: _________________________________________________________________________

Medications: ______________________________________________________________________

Person to contact in the event of an Emergency:

Name: _________________________________________ Relationship: ______________________

Address: ________________________________________________ Phone: __________________

Parent/Guardian or Secondary Person to contact in the event of an Emergency:

Name: _________________________________________ Relationship: ______________________

Address: ________________________________________________ Phone: __________________

Blood Type: _________ Do you have? Diabetes: ___Yes ___No Seizures: ____Yes ____No

Physical Limitation: _______________________________________________________________

Allergies: ________________________________________________________________________

Other Medical Information: _________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Mission Policy Agreement Hurricane Florence Recovery Trip February 9-16, 2019

United Methodist Volunteers in Mission I realize that the following commitment is crucial to the effectiveness, quality, and positive expression of our mission together. As a participating member of the United Methodist Volunteers in Mission team, I agree to: 1. Lift up Jesus Christ with my thoughts, words, and actions. * 2. Develop and maintain a servant attitude toward the people our team serves as well as toward each team

member. 3. Pray for and support my team leader and his/her decisions. 4. Respect the host's religious views, realizing that different people have different expressions of faith. 5. Accept both the ministry that is going on in the area where I am serving, and the local approach to the

mission. I understand that this may be different than my preferred approach. 6. Strive for harmony among team members, hosts, and people of the hosts’ society, keeping in mind local

conditions and customs. To do this I will follow the teachings of Christianity, the Golden Rule, and local societal customs and laws; avoid local taboos; use common sense and good judgment in all things; be considerate, tolerant, and patient with other customs, beliefs, and needs; and generally, set a good Christian example.

7. Abstain from using alcohol, tobacco, illegal drugs, and profanity; wearing inappropriate clothing;

and engaging in other objectionable behavior, from the time of my departure until my return home. 8. Refrain from negativism and complaining. Travel and ministry outside my church may present unexpected

and even undesired circumstances. However, my support and creativity will improve the situation. 9. Refrain from gossip. If it is not true, good, and positive, I will not say it. 10. Remember that I am a servant of Jesus Christ called to be in ministry with the host team. I will serve as

best I can so that both the spiritual purpose and the task of the mission will be accomplished. * Volunteers who serve in an emergency or disaster setting are asked to show their faith and love first by what they do. Conversations of a spiritual nature are appropriate in the context of the relationships we develop. We will respect and serve all persons whether they hold views similar to or different than ours. We will respect the right of all persons to not engage us in spiritual conversations. Signature provided on “Confirmation and Signature Form”

Participant Liability Release Hurricane Florence Recovery Trip February 9-16, 2019 Please read this agreement carefully before signing to fully understand your working relationship with The United Methodist Church North Carolina Conference Disaster Response. I, ___________________________________________________ acknowledge and state the following: I have chosen to travel to perform clean-up/construction work to repair or replace homes. I understand that this work entails a risk of physical injury and often involves hard physical labor, heavy lifting and other activity; including some that takes place on ladders and building framing other than ground level. I certify that I am in good health and physically able to perform this type of work. I understand that this is a “grass roots" activity to support individuals adversely affected by disaster or assisting to repair or replace substandard housing. I assume all risk and responsibility for any damage or injury to myself or my property and related medical costs and expenses which I may sustain while involved in this project. I understand that I am engaging this project at my own risk. In the event that my supervising organization arranges accommodations, I understand that they are not responsible or liable for my personal effects and property and that they will not provide 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 that time. By my signature, for myself, my estate and my heirs, I release, discharge, indemnify and forever hold The United Methodist Church North Carolina Conference, together with their officers, agents, servants and employees, harmless from any and all causes of action arising from my participation in this project, and travel or lodging associated therewith, including any damages caused by their negligence. Signature provided on “Confirmation and Signature Form”

Individual Skills Survey Hurricane Florence Recovery Trip February 9-16, 2019 Name ____________________________________________________ Please identify skills

Early Response Trained Skills CARE Teams

Chainsaw Operator Program Planning

Clean Up/ General Helper Licenced/Professional

Equipment Maintenance Electrician

General Operation Mason

Roof Tarper Painter

Basic Skills Plumber

Debris Removal Roofer

Demolition Foundation/Masonry

Painter Residential Construction

Clerical/Telephone/ Computer

HVAC Installation

Food Prep Counseling/ Mental Health

Do It Yourselfer (DIY) Crisis Intervention

Carpenter Casework

Sheetrock Installer Multilingual/Translator

Sheetrock Finisher Children’s Outreach

Door/Window Installer Elderly Outreach

Multilingual/Translator Other

Other skills & interests: ____________________________________________________________________ 

_________________________________________________________________________________________

_   

Confirmation and Signature

Hurricane Florence Recovery Trip February 9-16, 2019 I confirm that everything that all of my information on the following forms is accurate and filled out to the best of my ability. I agree to accept and abide by the terms on the Medical Release, Mission Policy Agreement, and the Liability Release forms. Please print this page to sign. ____________________________________________ Participant Name

__________________________________________________________________________ Physical Address, including City, State, Zip ____________________________________________ ___________________ Participant Signature Date ____________________________________________ ___________________ Parent / Guardian Signature for those under age 18 Date ____________________________________________ Witness Name ____________________________________________ ___________________ Witness Signature Date

DevelopingaSupportLetter

Mostofyourprayerandfinancialsupportforthistripwillcomefromtheseletters.Youwanttomakesuretheyareclearandprofessional.Herearesomesuggestions:

• First,startwithprayer!TrustGodtoprovideforthefinancialneedsofthistrip.AskHimtoguideyouindiscerningwhomtoask.Prayovereachpersonyouask.

• Therearemanypeoplewhoareinterestedinsupportingyouprayerfullyand/orfinancially.Forexample:

o Familyandfriends(Makealistlikeyouwouldforgraduationorweddinginvitations)

o PeopleyouknowintheCrossroadschurchfamilyo Networkfriends-youcangetnamesandaddressesofthepeopleyouare

connectedwiththroughFaceBook,orothersocialnetworks,andsendthemaletterore-mail.PostingonFacebookisnotusuallyeffective.

o Friendsfromyourworkplaceo FriendsinvolvedinotherChristiangroupsandministries

• Somepeoplerespondbesttolettersthroughthepostalservice,butsomeofyourcontactswillrespondbettertoanemail.

WritingYourLetterBeginyourletterbysharingtheopportunitybeforeyou.ExplainalittleaboutthesituationinFloridaasitrelatestothepurposeofyourtrip.Sharesomefactsaboutthestormdamageandcurrentconditions.Tellaboutyourpersonalmotivationforjoiningtheteam.Bebriefandbecarefulnottooverwhelmyourreader.Shareyourpassionforwhatyourteamwillbedoingthere,andwhyyouwanttobeapartofthisteam.InvitethemtoparticipatewithyouinmakingadifferenceinFloridathroughtheirprayerandfinancialsupport.Beasspecificaspossibleaboutthepurposeofyourteam(rebuildingRequestingFinancialSupportThereareaseveralkeypointsingivingthatmustbecontainedinyourletterinordertokeepyouandCrossroadscompliantwithIRSregulations.

1. Fordonationstobetax-deductible,thedonormustdonatethroughthechurch:• ChecksshouldbemadeouttoCrossroadsChurchwithyournameandUSMISSION

TRIPSinthememolineofthecheck.Checkscanbemailedto1000CrossroadsDrive,Oakdale,PA15071orplacedintheofferingbasketatanycampus.

• Supportcanalsobemadeonline.Gotothewebsitehere:http://crossroadsumc.org/giving/Choose“NEWGIVER,”then“USMISSIONTRIPS”under“SELECTAFUND.”Pleasebesuretoincludemynameinthe“optionalmemo”field.

2. Notethatonceyourindividualaccountgoalisreached,anyadditionalmoneywillbe

appliedtothepurposeandfocusofourdomesticmissiontrips.Also,ifforanyreasonyoucannotgo,theirdonationswillstillbeusedforthepurposesofthisorfuturedomesticmissiontrips.

3. [NotApplicabletothe2019FlorenceReliefTriptoNorthCarolina]Ifyouaregoingtoarrangeyourowntransportation,youwillneedtopurchaseyourticketoutsideofthisprocess.Youcanusedonationsfromotherstomakefunds,butthosechecksshouldgodirectlytoyouandwillnotbetax-deductible.

ConcludingPointsBeforemailingoutyourletterorpost,pleaseaskforreviewbyemailingtobothjudy@crossroadsumc.org (Crossroads’ treasurer) and relief@crossroadsumc.org

• Trytokeepyourletterdowntoonepageandbesuretohaveatleastoneotherpersonproofreadforerrorsormisspellings.

• Besuretoinvitethemtosupportyouandtheteamthroughprayer,eveniftheycannotgivefinancially.Askthemtoconsiderprayingassoonastheygetyourletterandtocontinueuntilyoureturn.Youmayalsowanttoinvitethemtoprayforthepeopleofyourdestination.

• Concludewithaprayerorwordofblessingforthem.• YouwillbenotifiedofdonationsmadetoCrossroadsinyournameweekly.Each

WednesdaythechurchofficewillprovideuswithanaccountingasofthepriorSunday,andthiswillbepassedontoyouonThursdaysorFridays.

• Keeptrackofyourdonationsandbesuretowriteanoteofthanksasyoureceivenotificationofdonations

October6,2017

InNovember,IwillbepartofateamfromCrossroadstravelingtoTexastorespondtoneedsasaresultofHurricaneHarvey.BecauseHarveyhitsuchabroadsectionofEastTexas,wewon’tknowexactlywherewearegoing(Houston?PortArthur?Beaumont?)untiljustaweekbeforethetrip.OurhostsinTexastellusthatmostoftheinitialclean-outofhomesisdone(removingcarpet,partsofwalls,furniture,etc.).BythetimewearriveNovember5,weexpecttobeassignedtorebuildingtaskssuchashangingandfinishingdrywall,cabinetinstallation,finishtrimandperhapsevensomepainting.

Welookforwardtomeetingnewfriendssuchasthewomanpicturedhere.Imaginewhatitmusthavebeenliketobestuckinyourhomewhilethewaterwasrising,waitingforhelptogettosafety–andnowhavingtocleanupandgetrebuildmuchoftheinteriorofherhouse.InmypriortripstoMississippiafterHurricaneKatrinaandtoNorthCarolinaaftertornadoesafewyearsago,Iamconstantlysurprisedandinspiredbytheresiliencyofthevictims,andamhonoredtoencouragetheirspiritandtomakeanimpactintheirphysicalrecoveryprocess.

Iwouldbemostappreciativeofyoursupportintwoways.

First,pleaseprayforthoseaffectedbythehurricanes,theteamtraveling,andforme.AskGodtopreparemyheartforthose“DivineEncounters”heisalreadyarranging,andforencouragementforallinvolved.

Second,Iaskthatyouprayerfullyconsidergivingfinanciallytothistrip.Mytotalcostforthetripis$650.AllthefundsareduebyOctober18th.Anyextrafundsraisedwillbeusedforthisorfuturedomesticmissiontrips.Ifyouwanttodonatetax-deductiblefundsformytrip,here'showtodothat:

o Online:Gotothewebsitehere:http://crossroadsumc.org/giving/Choose“NEWGIVER,”then“USMISSIONTRIPS”under“SELECTAFUND.”Pleasebesuretoinclude“PATRODDY”inthe“optionalmemo”field.

o Bycheck:MakeoutyourchecktoCrossroadsChurchandwrite“USMISSIONTRIPS–PATRODDY”onthememoline.YoucanputyourcheckintheofferingatanycampusormailittoCrossroadsChurchat1000CrossroadsDriveOakdale,PA15071.

Yourprayersanddonationsmakeadifference.ThankyouforyoursupportforwhatGodisdoingthroughCrossroads.

MayGodblessyou!