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800.968.8504 © 2019 YouthWorks
Please read through this document before you fill out
the paperwork.
Student Paperwork Packet Instructions youthworks.com
We’re looking forward to serving with you this summer. Part of getting ready for your trip includes completing paperwork. Please make sure that you and your parent or guardian are reading though these documents carefully so you know how to plan and what to expect on your mission trip. Forms we need you to complete, sign and turn in to your Trip Leader:
Please fill out the forms and return to _________________________ by ______________________. (Trip Leader Name) (Date paperwork needs to be turned in.)
¨ Community-Specific Release Form(s)
Some service partners we work with require additional release form documentation. These may or may not be included in this packet, based on the needs of the places you’ll serve.
¨ Participant Release Form (Note that while you can fill this out digitally, you’ll still need to print and sign it.)
¨ Youth Covenant Additional information to read before you pack your bag:
¨ Packing List & Clothes to Pack
Other information to be aware of:
¨ Background Check § We require that a background check be completed on all participants 18 and older (adult or
student). If you will be 18 at the time of your mission trip, please inform your Trip Leader, and they will handle the details around this process.
¨ Communication & Cell Phones § Trip Leaders will set up a communication with family and church members before the trip so
parents know how to get ahold of students while they are away. § We will support your church’s policy for students to leave their phones at home, but we
cannot promise that other groups will do the same. If your Trip Leader gives permission to bring cell phones, YW does have guidelines for their use; you can find those in the Youth Covenant.
¨ Dietary Concerns and Food Allergies § We are committed to offering a variety of food choices during the week. We recommend
that participants with allergies or special dietary needs bring supplemental food for the week. § Please direct additional questions to your Trip Leader; YouthWorks will work with them to
get answers to your questions.
Updated 11/14/13
YOUTH VOLUNTEER CONSENT
& PHOTO RELEASE FORM
Dear Parent or Guardian:
Thank you for encouraging your child to volunteer at Oregon Food Bank (OFB). Volunteers are crucial to our
mission to eliminate hunger and its root causes. OFB requires receipt of this release, signed by a parent or
guardian, before a minor may serve as a volunteer. Volunteers under 16 years must also be accompanied by
an adult. Please read and sign the following to give your child permission to volunteer at OFB. Feel free to call
503-972-2993 if you have any questions.
I acknowledge that I have reviewed the following:
1) My child may be working in an environment where forklifts, pallet jacks, and trucks are in use and where
heavy boxes of food are stacked on pallets.
2) My child may be working in an environment that may be hot, cold or dusty.
3) My child’s work will be supervised by an adult chaperone. I believe that my child is mature enough to
behave appropriately while he or she volunteers.
4) I understand that Oregon Food Bank occasionally photographs or videotapes activities held at its buildings
and at special events in the community, for use solely in connection with official Oregon Food Bank
publications, its web site, or in social media. By allowing my child to volunteer at Oregon Food Bank, I give
my consent for OFB to record and use my child’s image to raise awareness about OFB and its mission. If
you do not wish for your child to be photographed, please check here:
I release Oregon Food Bank, its sponsors, employees, board members, volunteers and agents from any and all
claims and liabilities (including costs and attorney fees) arising out of or in any way connected to my child’s
volunteer activities, unless the claim is based upon the conduct of an Oregon Food Bank employee in the course
and scope of his or her employment. I further agree to indemnify and hold Oregon Food Bank harmless from
any and all claims arising from my conduct or the conduct of my child while he or she is volunteering for
Oregon Food Bank.
Name of Youth (PRINT LEGIBLY) FIRST:_____________________LAST:_________________________
Youth’s Date of Birth _________________________, _______________, ____________________
(month) (day) (year of birth)
Name of Parent/Guardian (print)_______________________________________________________________
Signature of Parent/Guardian_____________________________________________ Today’s Date ________________
ŀ Print Minor’s Name:__________________________________
Volunteer Consent and Release Form for Minors
1. Voluntary Participation: I acknowledge that my child ________________________________ is under
the age of 18, a legal minor and has voluntarily applied to a volunteer role at Portland Rescue Mission. I
understand that my child will not be paid for his/her services, that he/she will not be covered by any
medical or other insurance coverage provided by Portland Rescue Mission, and that he/she will not be
eligible for any Worker’s Compensation benefits.
2. Release: In consideration of the opportunity afforded my child to volunteer at Portland Rescue
Mission, I hereby agree that I, my child, my assignees, heirs, guardians, and legal representatives, will
not make a claim against Portland Rescue Mission, any of their staff, program participants or guests,
collectively or individually, for the injury, loss of my child, or damage to his/her property, however
caused, arising from his/her participation at Portland Rescue Mission. Without limiting the generality of
the foregoing, I hereby waive and release any rights, actions, or causes of action resulting from personal
injury or loss to my child, or damage to his/her property, sustained in connection with his/her
participation at Portland Rescue Mission. I further consent to the use of Portland Rescue Mission and/or
person(s) authorized by them of any photographs, recordings, interviews, videotapes, or similar visual
recordings of my child.
___________________________________ _______________________________________
Parent/Guardian (Signature) Parent/Guardian (Printed Name)
Date: ______________________________ _______________________________________
Portland Rescue Mission Representative
IN CASE OF EMERGENCY, PLEASE CONTACT ME AT: (_______)_________________________
Phone
_____________________________________________________________________________________
Address
_____________________________________________________________________________________
City State Zip Code
Permission to Use Photograph/Video
Event: Photography at Ronald McDonald House Charities
I grant to Ronald McDonald House Charities® of Oregon and Southwest Washington (RMHC),
the right to take photographs/video of me and my family to use in marketing and fundraising
materials such as fundraising videos, newsletters, electronic communications, marketing
collateral, and social media content. I authorize RMHC, its assigns and transferees to copyright,
use and publish the same in print and/or electronically. I agree that RMHC may use such
photographs/video of me with or without my name and for any lawful purpose, including for
example such purposes as publicity, illustration, advertising, web and social media content.
I have read and understand the above:
Printed name ___________________________ Signature___________________________
Address ______________________________ Email _____________________________
Phone Number ________________________ Date ________________________________
Child _________________________ Age ________
Child _________________________ Age ________
Child _________________________ Age ________
Child _________________________ Age ________
Signature, parent or guardian (if under age 18)
___________________________________________________________
1
VOLUNTEER AGREEMENT
● Release of Liability
● Confidentiality Agreement
● Non-fraternization Policy
● Volunteer Guidelines
RELEASE OF LIABILITY
Volunteer and his/her/their assignees, heirs, distributees, guardians, and legal representatives will
release, defend, indemnify, keep and hold harmless the Organization, its employees, agents and other
volunteers, from all damages, judgments, expenses (including reasonable attorney fees) costs or
liabilities in law or equity arising from or in any way related to Volunteer’s activities, services, or duties
as a volunteer under this Agreement or for any negligent act or omission by the Organization, its
officers, directors, employees, and agents, or suffered because of the injury to, or the death, of any
person or persons, or because of damage to property that may arise out of, or as a consequence of,
Volunteer’s negligent or intentional acts while engaging in activities, services, or duties as a volunteer
under this Agreement.
CONFIDENTIALITY AGREEMENT
As a volunteer for Ronald McDonald House Charities® of Oregon and Southwest Washington (RMHC), I
realize that I may come into contact with confidential or proprietary information of RMHC. I understand
that I may not share confidential or proprietary information with anyone other than an RMHC officer,
volunteer, or employee. Confidential or proprietary information includes, but is not limited to: House
guest and family member identity, personal, medical and financial information; RMHC financial,
personnel, strategy, and operational information; and RMHC donor identity, personal and financial
information. I realize that any such disclosure may place both RMHC and me at risk.
I understand that I am encouraged to share the positive experiences I have while volunteering for RMHC
with friends, family and community members. However, I will avoid disclosing to any unauthorized
person any information of a personal, private, or confidential nature about the families who call the
Ronald McDonald House their “home away from home.”
If anyone should contact me and request what I believe to be confidential or private information, I will
immediately refer them to an RMHC staff member.
2
NON-FRATERNIZATION POLICY
All volunteers must maintain a professional relationship with all families staying at the Houses. All
families must be treated equally, and no family should feel left out or given the impression that another
family receives special treatment. Maintaining a professional relationship will help to protect families
and volunteers from accusations of inappropriate behavior – whether real or imagined. It is
understandable that volunteers have compassion for the families that stay in the Houses, however,
volunteers are there to support families through their times of crisis and to do so without real, implied
or imagined social obligations.
1. General: Volunteers may not engage in any social activity with current House guest families, either
during normally scheduled working hours, or during off-duty hours without the prior approval of their
supervisor. Volunteers may interact with House guests while participating in regularly scheduled House
activities and programs, such as the family meal program and Fun Junction.
2. Communications: Because the nature of the relationship between volunteers and guests depends
upon the volunteer’s responsibilities, policies are slightly different for Operations verses Development
volunteers.
a. All volunteers:
i. Volunteers may not engage with guests on private social media accounts, including
friending on Facebook and following on Instagram.
ii. Volunteers may provide current guests with their work email addresses and work
telephone numbers.
iii. Volunteers may communicate with current guests via the RMHC Facebook account.
iv. Volunteers may access a family’s public, medical-related site, such as Caring Bridge.
v. Any personal contact that has been established by volunteers prior to the effective
date of this policy may remain in effect.
vi. Any personal contact that predates an individual becoming a guest at the Ronald
McDonald House may remain in effect.
vii. Any volunteer who feels that special circumstances justify making an exception to
this policy should talk with his/her/their supervisor.
b. Operations volunteers:
i. Operations volunteers may not provide current guests with any personal contact
information, including, but not limited to, personal telephone (including cell phone)
numbers and personal email addresses.
ii. Prior to providing a past guest with any personal contact information, the Operations
volunteer must get the approval of the Operations Management.
3
c. Development volunteers:
i. Development volunteers may provide current and past guests with personal contact
information if they feel it is appropriate, provided they obtain permission from a
supervisor; for example, when a guest is making a personal appearance at a fundraising
event.
3. Gifts:
a. Individual volunteers may not accept a personal gift from a family valued at more than $25.
Volunteers may accept gifts from families that are meant to be shared with all volunteers.
b. Individual volunteers may not accept a tip or gratuity from a family. Anyone offered a tip or
gratuity should express their appreciation, and suggest that the family instead make a donation
to RMHC.
c. Individual volunteers may not give personal gifts to families staying at the House, unless all
families have the opportunity to receive the same gift.
d. Individual volunteers may donate items to be shared by all families staying at the House.
4. Hospital visits: On occasion, volunteers may be asked to visit an ill child in the hospital. Volunteers are
welcome to do so within certain parameters:
a. Volunteers may not visit an ill child unless specifically requested by the child’s parent or legal
guardian.
b. When visiting an ill child, volunteers should notify the Volunteer Manager prior to doing so.
5. Funerals: On occasion, volunteers may be asked to attend the funeral for a child who has passed
away. Volunteers are welcome to do so within certain parameters:
a. Volunteers should not attend a child’s funeral unless specifically requested by the child’s
parent or legal guardian.
d. When attending a child’s funeral, volunteers should notify the Volunteer Manager prior to
doing so.
6. Any volunteer who violates this policy is subject to disciplinary action, up to and including termination
or dismissal.
VOLUNTEER GUIDELINES
Age Requirements: Volunteers must be at least 16 years of age to volunteer at the House unsupervised.
Children 8-12 years old may volunteer with an adult, but cannot volunteer in the kitchen or participate
in baking or meal preparation. Children 13-15 years old may volunteer in the kitchen and all parts of the
House but must have adult supervision at all times.
4
Illness: Anyone with symptoms of illness should not enter the house. You must be symptom free for at
least 48 hours before coming to the House. Symptoms of illness may include: sore throat, runny nose,
watery eyes, fever, chills, unexplained rash, achiness, nausea, vomiting or diarrhea. Anyone who has
recently been exposed to chicken pox, measles, shingles, TB, hepatitis or E.Coli may not be inside the
House or interact with guests. Bring any health concerns to your Volunteer Manager.
Volunteers Accepted Based on RMHC Needs: RMHC accepts the service of volunteers based on our
needs at any given time. RMHC may at any time, for any reason, decide to terminate a volunteer’s
relationship with RMHC or to make changes in the nature of any volunteer assignment. Volunteers may
also at any time, for any reason, choose to end their relationship with RMHC and should notify their
Volunteer Manager promptly.
Dress: Volunteers should wear clothes that are appropriate for the job they will be performing. Clothes
should be clean, modest, and comfortable.
Guest Rooms: Volunteers may not be alone with any families in their guest room. Only staff will
authorize entrance into family’s room. Under certain circumstances, such as preparing a room for check-
in or when repairs are needed, a volunteer may be asked to enter a family’s room to perform a needed
task.
Appropriate Physical Contact: Only guests should initiate appropriate physical contact. Volunteers
should be aware that every person has different levels of comfort with physical contact and it may vary
day to day. It is completely appropriate to ask the guest if they would like physical contact (a hand to
hold, a hug, etc.). Always be respectful of their answer and their boundaries – do not take it personally.
When interacting with a child, remember that both parents and children have their right to decline
physical contact. Be respectful and always ask both the parent and child if physical contact is ok.
Volunteers also have the right to determine their own comfort with physical contact. It is important for
volunteers to voice their own feelings and concerns about touch that is received from other volunteers,
staff, or guests. If, at any time, a volunteer is uncomfortable with any situation involving physical
contact, the volunteer should immediately consult a staff member.
Religious or Political Beliefs: Ronald McDonald House is a secular organization. We serve families from
all faiths and backgrounds. Please do not initiate conversations regarding religious or political beliefs. If
you are engaged in a conversation by a guest, remain respectful and do not expound on your own
personal religious or political beliefs.
Grievance Procedures: We want the Ronald McDonald House to be an environment of caring and
support. We encourage you to bring any questions, concerns or complaints to our attention. If a
volunteer has a problem with another volunteer, a staff member, or a guest they are urged to speak
with the Volunteer Manager, House Manager, Community Engagement Manager, or trusted staff
member who will respond accordingly. If the volunteer does not receive an adequate response or
intervention, volunteers should bring the issue to the attention of the Chief Operations Officer.
Resignation: Volunteers may resign for any reason, at any time. When possible, we request that you
provide at least two weeks’ notice to your Volunteer Manager.
5
Termination: We expect our volunteers to exemplify respectful behavior. Volunteers may be terminated
for the following reasons, including, but not limited to: destruction or damage to RMHC property or
supplies, or the property of employees, guests, or volunteers; stealing or removing RMHC property, or
the property of employees, guests, or a volunteer without permission; lying or giving false or misleading
information when applying for a volunteer position; bringing or possessing firearms, weapons, or other
hazardous or dangerous devices or substances; harassing, threatening, intimidating, or coercing staff,
guests or volunteers.
Discrimination & Harassment: RMHC does not discriminate based on race, gender, national origin, age,
religion, sexual orientation (including gender identity), disability or any other status or characteristic
that is protected by applicable nondiscrimination laws. Staff and volunteers are expected to conduct
themselves with maturity and professionalism in all they do. Engaging in harassing, discriminatory or
other objectionable behavior, including epithets, jokes, and hostile or degrading comments, is subject to
discipline, which may include immediate dismissal.
If a volunteer feels they are being harassed or discriminated against in any way, they should consult
their supervisor, or another RMHC staff member, immediately.
Smoke & Scent Free Policy: The hospital campus, including Ronald McDonald House, is smoke and scent
free. The burning of incense and candles is prohibited. Since many patients are very sensitive to strong
smells we ask that you do not wear any perfume or cologne. If you smoke, please take steps to eliminate
any residue or smells before coming to the House.
Weapons and Dangerous Devices: No volunteer may possess a firearm, weapon, or other dangerous
device on RMHC property. This includes volunteers who have concealed weapons permits.
Alcohol & Drug Policy: RMHC promotes a workplace free from the influence of drugs and alcohol.
Working under the influence of alcohol, illegal drugs, or misused prescription drugs and other related
conduct threatens the safety of other volunteers, employees and House guests. RMHC prohibits
volunteers from consuming alcohol or being under the influence of alcohol during working time.
Driving RMHC Vehicles: Volunteers with a valid driver’s license and good driving record may drive an
RMHC provided vehicle with permission. Using a personal vehicle to transport guests is prohibited.
Transporting a child requires a parent or guardian to be present and an appropriate car seat.
I have read this release and understand and agree to its terms. In responding to this question I affirm
that I am at least 18 years of age, or the parent/guardian of the volunteer.
___________________________________________________ _____________________
Signature of Volunteer/Parent or Guardian of Volunteer Date
MEDICAL CONSENT FORM and LIABILITY RELEASE AGREEMENT
NAME OF PARTICIPANT: NAME: ______________________________________________ AGE: ___________
NAME OF PARENT/GUARDIAN (printed): __________________________________________________
HOME ADDRESS: _____________________________________________________________________
TELEPHONE NO: __________________________ CELL PHONE: _____________________________
In the event of accident, injury or illness involving any child of mine (specifically including my child, named above as
the "Participant") or me or my spouse while in, on, or about the premises of BridgeTown Inc., or while participating in
any activity sponsored by or under the auspices of BridgeTown Inc., under circumstances where I am physically unable
to consent or am not present:
1. I hereby voluntarily authorize and consent to the furnishing to myself, my spouse, or any child of mine of such
medical care, attention, and treatment by any hospital, physician or dentist as such hospital, physician or dentist may
deem necessary or advisable, including any x-ray examination, anesthetic, medical, or surgical diagnosis or procedure.
2. I authorize any adult associated with the activity to consent to such medical care, attention and treatment.
3. I agree to pay the reasonable cost of such medical care, attention or treatment, and to indemnify, and hold free and
harmless of and from any and all liability for such cost the assisting adult, BridgeTown Inc. officers, employees and
members of said organizations.
It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that
any of the above treatment will not be withheld if the undersigned cannot be reached.
ALTERNATIVE PERSONS TO CONTACT:
______________________________________________________________________________________
NAME RELATIONSHIP PHONE NUMBER
PRIMARY CARE PHYSICIAN:
______________________________________________________________________________________
NAME PHONE NUMBER
ATTACH COPY OF HEALTH INSURANCE CARD, OR COMPLETE THE FOLLOWING:
______________________________________________________________________________________
HEALTH INSURANCE CARRIER INSURANCE ID NO. NAME OF INSURED
_______________________________________
PHONE NO. FOR VERIFICATION
I agree that a photocopy of this consent, or a copy sent by fax, may be accepted by any health care
providers. This consent shall be valid for one (1) year from the date of signing.
LIABILITY RELEASE AGREEMENT
IN CONSIDERATION OF ACCEPTANCE OF MY OR MY CHILD’S REGISTRATION TO PARTICIPATE IN
ANY EXPERIENCE OPPORTUNITY PRESENTED BY BRIDEGTOWN INC., RECOGNIZING THE RISKS
ASSOCIATED WITH AN ACTIVITY OF THIS TYPE, THE UNDERSIGNED HEREBY WAIVES ALL CLAIMS
FOR PERSONAL INJURY AND PROPERTY DAMAGE AND HEREBY RELEASES BRIDGETOWN INC.
AND
THEIR DIRECTORS, OFFICERS, MEMBERS, EMPLOYEES, AND THE BRIDGETOWN VOLUNTEERS
AND SPONSORS, OF AND FROM ANY AND ALL CLAIMS, INCLUDING THOSE OF NEGLIGENCE AND
GROSSNEGLIGENCE, WHICH I OR MY CHILD MIGHT HAVE, ARISING OUT OF MY CHILD’S OR MY
OWN PARTICIPATION IN ANY AND ALL ACTIVITIES RELATING THERETO.
SIGNATURE OF PARENT/GUARDIAN: _______________________________________________
DATE: _______________________________________________
TSA Form Updated 8/14/2015
The mission of The Children’s Book Bank is to increase the chances for children to succeed as future readers, learners, and citizens by filling their homes and lives with quality books.
1915 NE 7th Avenue, Portland, OR. 97212 | 503 616-3981 | www.childrensbookbank.org
YOUTH VOLUNTEER WAIVER AND PHOTO RELEASE
Volunteer Name Date of Birth Date
Emergency Contact Name (other than chaperone present) Emergency Contact Phone
How will you be joining us today?: Hands On Greater Portland School Group Organization
By signing this agreement, I acknowledge my child and I have reviewed and agree to the following statements (Please mark each statement noting your agreement):
Volunteers will be working in a warehouse environment where heavy boxes of books are stacked. The work is done while seated. Our workspace has heat but no air conditioning and the temperature has been known to fluctuate depending on the weather outside. Volunteers will be using cleaning products during their shift
Volunteers under the age of 15 must be accompanied by an adult volunteer who agrees to participate & actively supervise their children and their work. Children must remain in the work area and not wander around the warehouse.
I understand activities hosted by The Children’s Book Bank are routinely photographed solely for official use in CBB publications, on CBB website, or on CBB social media. By allowing my child to volunteer at The Children’s Book Bank, I give my consent for CBB to use my child’s image to raise awareness about CBB and its mission.
Please check here if you do not wish for your child to be photographed
In connection with my child's voluntary involvement in activities undertaken for, and with the participation and support of The Children’s Book Bank, a non-profit charitable organization, I hereby agree to release and discharge The Children’s Book Bank, its officers and directors, employees, agents, and volunteers for all claims, demands, and actions for injuries sustained to my person and/or property as a result of my child's involvement in such activities, whether or not resulting from negligence, and I agree to release and hold The Children’s Book Bank, its officers and directors, employees, agents and volunteers harmless from any cause of action, claim, or suit arising there from. I hereby attest that my child's’ attendance and involvement in such activities is voluntary, that he/she is participating at their own risk, and that I have read the foregoing terms and conditions of this release. VOLUNTEER INTENDS THIS RELEASE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
Parent/Guardian Signature Date
Parent/Guardian Name Email Address
800.968.8504 © 2019 YouthWorks Page 1
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Participant Release Form – All Other Sites Do not use this form if you are going to: Adirondack Mountains, Brooklyn, Harrisburg, Niagara Falls or Philadelphia
Name of Participant (please print): Grade as of Fall 2018 (if student):
Dates Attending: Name of Trip Site:
Church Name:
Trip Leader:
Consent/Liability Release Agreement: The undersigned individual(s), as either the above named trip participant if age 18 or older or the legal guardian(s) of the above named minor trip participant, hereby consent to the above named trip participant (the “Participant”) participating in the above-referenced YouthWorks mission trip and related activities, including but not limited to travel to and from the trip location (the “Trip”). I/we agree that there are inherent risks involved in participation in the Trip and that participation is voluntary, and I/we would like the Participant to take part in the Trip. I/we have independently investigated the risks associated with the Trip and hereby accept(s) and assume(s) all such risks, including both known and unknown risks. I/we understand that if the Participant feels unsafe or uncertain about how to safely perform any task or activity on the Trip, the Participant is responsible to not perform the task or activity unless and until he/she is certain how to safely do so. I/we also understand that YouthWorks is not a representative or agent of, and cannot control the acts or omissions of, any transportation carrier, lodging provider, or other service/goods provider involved in the Trip. I/we further understand that YouthWorks is not responsible for any loss, theft or damage to Participant’s personal property during the Trip. I/we understand that YouthWorks is a Christian organization and the Trip will include faith-based discussions or activities. I/we, on behalf of myself/ourselves, the Participant, and all of our legal representatives, heirs, successors, assigns, and any other person or entity that could bring a claim on my/our and/or the Participant’s behalf (collectively, the “Participant Parties”), hereby release and discharge YouthWorks, its affiliated organizations, and any of their former, current or future directors, officers, employees, volunteers, and agents (collectively, the “Released Parties”), from any and all claims, liabilities, damages, or costs that any of the Participant Parties may have or claim to have relating to or arising out of participation in the Trip, including without limitation injury, illness, death, medical costs, property loss, and negligence on the part of the Released Parties. I/we also agree to indemnify, defend and hold harmless the Released Parties from any and all claims, liabilities, and costs asserted by any of the Participant Parties. I/we understand that, during the Trip, the Participant may be photographed or recorded and hereby authorize and agree to YouthWorks’ or its affiliated organizations’ unrestricted use, reuse and distribution of images and recording including but without limitation for purposes of promoting and publicizing mission trips. I/we understand that use of such materials will be without compensation and my/our further approval hereafter. Transport Home Agreement: I/we understand that there could be a need for the Participant to be sent home from the Trip due to illness, injury, a disciplinary or policy issue, or some other reason. If the Participant is required to return home during the Trip, I/we agree that Participant will be transported home at my/our expense. YouthWorks or an adult leader of the trip group will contact me/us or an emergency contact for Participant regarding such transportation. Medical Release Agreement: I/we agree that I/we are responsible for the Participant’s medical needs. There either are no health-related issues which restrict Participant’s participation in this Trip or which require special assistance, or I/we have confidentially arranged with YouthWorks for such assistance. I/we understand that accident/health insurance for Participant and any medical costs incurred by Participant while on the Trip are my/our responsibility. If the Participant is ill or injured while on the Trip and requires medical attention, I/we consent to any reasonable medical treatment deemed necessary by a qualified medical professional. If a medical professional refuses to administer treatment to Participant without my/our consent and I/we are not timely available to provide such consent, I/we authorize the Trip Leader or a member of the YouthWorks staff to give such consent. In the event it becomes necessary for such person to give consent, I/we, on behalf of the Participant Parties, agree to and do hereby release and hold him/her and all of the Released Parties harmless of any claims, demands or suits for damages arising from the giving of such consent or any resulting medical treatment.
800.968.8504 © 2019 YouthWorks Page 2
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Participant Release Form – All Other Sites Do not use this form if you are going to: Adirondack Mountains, Brooklyn, Harrisburg, Niagara Falls or Philadelphia
Emergency Contact Information (please provide two) Name: Name:
Relationship to Participant: Relationship to Participant:
Home Phone: Home Phone:
Work Phone: Work Phone:
Cell Phone: Cell Phone:
By signing below:
• I/we represent that I/we have read this Participant Release Form in its entirety, including its sections titled Consent/ Liability Release Agreement, Transport Home Agreement, and Medical Release Agreements, and I/we hereby agree to its terms;
• I/we represent that (i) I am the above-named trip participant and am at least 18 years of age with legal authority to sign this form on my own behalf; or (ii) I/we are the parent(s) with legal custody of the above-named minor trip participant or are otherwise the legal guardian(s) of such minor trip participant;
• I/we agree that the Participant Release Form shall be governed by Minnesota law; and • I/we represent that all of the information I/we provided on this Form and any related medical
information form is accurate. Trip Participant Print Name: if 18 or older Signature: Date:
Telephone: _____________ Email: _______________________________
OR Parent/Guardian (1) Print Name: of Minor Participant Signature: Date:
Telephone: ___________________ Email: _________________________ Parent/Guardian (2) Print Name: of Minor Participant Signature: Date: Telephone: ___________________ Email: __________________________
800.968.8504 © 2019 YouthWorks Page 3
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Bring original form and 2 copies to site
Participant Release Form – All Other Sites Do not use this form if you are going to: Adirondack Mountains, Brooklyn, Harrisburg, Niagara Falls or Philadelphia
CONFIDENTIAL The section below will be stored confidentially by YouthWorks. Medical Information* Participant Name: Date of Birth: / /
Home Address: Phone:
Date of Last Tetanus Shot:
Known Allergies:
Current Medications and/or Health Conditions:
*To be used only to determine course of treatment in the event of a medical situation.
Insurance Information* Name of Health Insurance Company:
Health Insurance group number: Health insurance policy number:
Phone/address of health insurance company:
Name of policy holder:
Policy holder’s phone number:
*Participants without health insurance may still be allowed to attend, understanding the risks and personal liability to any and all medical payments. *Please attach a copy of your insurance card to this form. It will be destroyed after the trip is completed.
800.968.8504 © YouthWorks 2019
You’re about to meet some new people in a new place and hopefully learn some pretty incredible stuff! But before you do, there are a couple things we want everybody to agree on, so your trip will be the best it can be. We’ve thought carefully about what’s important for everyone to see eye-to-eye on and listed those things below. These expectations will help to make this experience meaningful, fun and safe for everyone – and by “everyone,” we mean YouthWorks staff, community members, adult leaders, other students and, especially, you!
Please read this covenant carefully so you understand YouthWorks policies. By signing at the bottom, you’ll be agreeing to respect the community you are serving and commit to being a team player in your group.
� I agree to look for ways to serve others with a joyful attitude, so I can help people like Jesus did. I understand that I am on the trip to serve God, help a community, build new relationships and learn new things. I agree to come prepared to do just that!
� I am aware that my actions affect people other than just me. I agree to obey all local laws and ordinances pertaining to use of drugs and alcohol by minors. I will not bring or use any weapon or illegal substance during my mission trip week.
� I want to stay focused on the people and
experiences in the community I will be visiting. Because of this, I will consider leaving my cell phone or other electronic devices at home. If I choose to bring them, I understand that my use of them will be limited, and I will risk theft or loss. I understand that my parents will be given instructions on how to contact my adult leaders in case I need to be reached.
� I want to respect the people around me, so I agree
to bring clothes inline with YouthWorks’ “Clothes to Pack” list.
Bring Signed Form to Site
YOUTH COVENANT
youthworks.com
� I agree that this mission week is a group experience. I’ll be in different group settings all week. Because of this, I will do my best to build community, create relationships, be welcoming and include others. I agree to treat everyone – leaders, staff, other students and community members – with the utmost respect.
� I realize that there are adults in my life and on
the trip who care about my well-being. Plus, I want to be safe! So, I agree to stay within the designated YouthWorks boundaries, follow rules at ministry sites, stay in groups of three or more, respect gender-specific areas (sleeping rooms, restrooms and showers), and refrain from using my cell phone in these areas due to privacy concerns.
� It matters how I treat people’s things, so I
agree that I will respect the property of all participants, the community members and the housing site where we stay. My actions will show my love for Jesus and others. I will keep in mind the purpose of the trip and my job of representing Jesus to the community.
I agree to follow all the above expectations because I want to be safe, love others and represent Jesus well at all times.
_________________________________________________ ______________________________ Student Signature Date _________________________________________________ _______________________________ Parent/Guardian Signature Date
800.968.8504 © YouthWorks 2019
Notes on Packing
Because space is limited in the sleeping rooms, everything but your sleeping bag and camping pad or air mattress should fit in one duffel bag or suitcase.
Please check the local weather forecast for the community you are visiting to help you know how to pack.
PLEASE AVOID BRINGING: � Blow dryers, curling irons or straightening irons
because shower time is short and because many of our housing sites do not have the power to run all of these small electronics at one time.
� Electronic devices, too much cash or other valuables that you would consider to be irreplaceable. Also, consider leaving your phone at home. These items can distract you from others during the week and may be susceptible to theft. YouthWorks is not responsible for any lost or stolen items.
For Everyone
CLOTHING As you pack clothes for your trip, make sure you’ve read the page entitled “Clothes to Pack for Your Mission Trip.” It has lots of information to help you pack well! � Mid-thigh or longer shorts* � Long pants
for cool nights and/or work projects � Short-sleeved shirts* � Long-sleeved shirts, sweatshirts and/or light jacket
for cool nights � Nice, clean clothes for a possible worship service � Underwear and socks � Tennis shoes or work boots (closed-foot)* � Swimsuit*
for showering if you wish and/or possibly for an evening activity (ask your Trip Leader)
� Towel and washcloth � Shower shoes (flip-flops) OTHER STUFF � Small shower bag or backpack � Soap, shampoo, deodorant, other toiletries, extra
contact lenses, backup pair of glasses, etc. � Sleeping bag and pillow � Air mattress or camping pad
for sleeping on floors; mattresses must be twin size or smaller
� Bible and pen � Reusable water bottle � Sunscreen, lip balm, hat, sunglasses � Spending money for snacks and T-shirt purchases
talk to your Trip Leader for further details � Insect repellant
not every person needs to bring their own; coordinate with others in your group
� Flashlight � Battery-powered alarm clock
not every person needs to bring their own; coordinate with others in your group
For Canadians going to United States Sites OR United States citizens going to Canadian Sites
� Bring appropriate documents for border crossing. See Border Crossing Info under Required Paperwork.
� Exchange your money before your trip. This can take up to a few weeks.
For those going to Puerto Rico
� Because of space limitations, do not bring an air mattress. Please bring a foam pad or camping pad. Need to buy something? We suggest the Coleman Slim Twin.
� The summer is rainy season in PR – a small umbrella or raincoat is a good idea and bug spray is essential!
� We will be attending a Puerto Rican church service. It is important to be culturally sensitive with our clothing. Appropriate clothing for church includes: • For women: at-least-knee-length skirts/dresses or
shorts/capris and a nice loose-fitting shirt with sleeves; please no sleeveless dresses or shirts
• For men: pants or knee-length shorts, preferably khakis with a short sleeve button-down shirt or polo shirt
• For everyone: Sandals are appropriate.
* See “Clothes to Pack for Your Mission Trip” for additional details.
PACKING LIST youthworks.com
800.968.8504 © YouthWorks 2019
We want you to be successfully in service! It might seem small, but being intentional with what you wear can help you eliminate obstacles when serving others. Because we get to be guests in another place, we want to do everything we can to respect others, including honoring their ideas about apparel. Plus, we’ll be doing a lot of different kinds of service, so we want you to be ready for whatever this mission trip throws at you!
Bringing the following items on your mission trip will allow you to bypass potential barriers, participate in all sorts of service, and stay safe as you enter into another community and actively love others.
We know that some of the items on this list might not match up with what you usually wear. Sometimes service stretches us beyond what we’re used to… and that’s OK! Mission trips are all about moving into new territory and experiencing something different. Plus, it’s kind of incredible that something as simple as how you pack your bags can be part of the way you begin to serve the community you’re headed to. Thank you for serving in this way!
Please Leave at Home…
• Tank tops or sleeveless shirts • Short shorts • Clothing that reveals
undergarments, midriffs or chests • Tight-fitting clothing • Clothing with obscene, vulgar,
abusive or discriminatory language or images
• Attire that represents hate groups, contains threatening language or is gang-related
• Apparel that promotes alcohol, chemicals, tobacco or any other product illegal for use by minors
Why? We don’t want something as simple as clothing to hurt your opportunity to form incredible connections with other church groups on the trip or our friends in the community. Instead, we want to honor those relationships by avoiding attire that could possibly conflict with their cultural or organizational norms.
Please Bring…
Tennis Shoes or Work Boots You can bring sandals too, but to keep your feet safe, you’ll need a pair of closed-foot shoes that completely covers your feet. Bring footwear that you don’t mind getting dirty or wet at service sites and that you can wear in the kitchen.
Mid-Thigh or Longer Shorts or Pants Not sure if that’s your shorts? Let your arms fall to your side; if your fingertips touch skin, look for a longer pair to bring along.
Shirts with Sleeves They don’t have to be long sleeves and you can roll them up anytime. Loose-Fitting Clothing During the week your clothes may endure paint, sweat, mud and lots of love from children! Bring clothes that you can work and play hard in.
Swimwear If your YouthWorks week includes a swimming activity:
Guys: Please follow the shorts policy above. Girls: Please bring a one-piece swimsuit.
If you are bringing a suit for additional privacy in the shower, two-piece suits are OK.
CLOTHES TO PACK FOR YOUR MISSION TRIP
youthworks.com
