Hurricane Recovery Volunteer Form

Group Registration Form

This form is for group leaders and individuals who are willing to join with other groups on-site. Individuals who are part of a group do not need to complete this form.

Completing this form does not guarantee placement. The requests will be placed in the schedule in the order this completed application is received. Groups are requested to arrive on Sunday and depart on the following Saturday. You will be contacted to confirm the dates you have requested. If your requested date is full, you will be asked about the possibility of your service on another date.

Volunteers must be at least 16 years of age. Volunteers under the age of 19 must return the parental release form. All volunteers in each group must return liability release forms. These forms are due to the Disaster Recovery Coordinator, Little Farms UCC, 135 Suave Road, River Edge, LA 70123 at least 3 weeks before your confirmed date of arrival. Forms are available here.

A donation of $50 per person per week or $10 per day if less than a week, is suggested to defray housing costs. This is payable on-site.

Any questions? Please contact Volunteer Coordinator at ucchurricanerecovery@yahoo.com or by phone 504-258-7306 or UCC South Central Conference Minister for Disaster Response and Recovery, Rev. Alan Coe at revacoe@yahoo.com.

Church/Organization Information (for informational purposes)
Church Name
Church Address
Church City
Church State
Church Zip Code
UCC Conference
Contact Person (the one completing this form)
Full name
Address Line 1
Address Line 2
City
State/Province
Postal Code
Phone
Evening Phone
Cell Phone
Fax
Email
Group Information
First Choice for Arrival/Departure Dates
Second Choice for Arrival/Departure Dates
Place the estimated number of persons in each age and gender category.
Number of people in the group ages 16-19
Number of people in the group ages 20-35
Number of people in the group ages 36-49
Number of people in the group ages 50-65
Number of people in the group age over 65
Number of women in the group
Number of men in the group
Indicate the number of volunteers in your group with skill in each trade category listed below.
Concrete (forming/ pouring/finishing)
Masonry ( block/brick)
Plumbing
Electrical
Heating/Cooling
Rough Carpentry (framing/repairs)
Finish Carpentry (doors/cabinets/trim)
Roofing
Hanging drywall
Finish drywall
Siding (vinyl/aluminum/wood)
Painting
Laying carpet
Laying linoleum
Tree removal
Power Tools, Heavy Equip
Trade Licenses held
State/s of licnesure
Donations
Specify building material donations, if any
Specify amount of cash contributions, if any
Special Requests
Comments/Additional Information
How did you learn about this disaster recovery program?
 
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CONTACT INFO

Rev. Mary Schaller Blaufuss
Team Leader
700 Prospect Ave.
Cleveland,Ohio 44115
216-736-3214
blaufusm@ucc.org