VOLUNTEER FORM

This form has multiple parts:
  • Contact information (your name, etc.)
  • Your skill set (what you do)
  • Medical, beneficiary, and emergency contact information
  • Previous experience with medical/dental missions
  • Your preferences (what trip may work for you)
  • Personal statement



CONTACT INFORMATION


Prefix:
First Name:
Middle Name:
Last Name:
Suffix:
Address 1:
Address 2:
City:
State:
Zipcode:
Country:
Phone:
Email:
Confirm Email:
Date of Birth:



YOUR SKILLS


Language Skills


Spanish Speaking Ability:
Spanish Reading/Writing Ability:


Professional Area of Expertise

Profession:
Area of Expertise:
Years of Experience:
Workplace Setting:




MEDICAL INFORMATION

If there are medical concerns we should know about, please indicate below.

Do you have any current medical conditions?
If yes, please explain:


Do you have any allergies?
If yes, please explain:


Will you be on any medications while in Honduras?
If on medications while in Honduras, which ones?:
Are you a vegetarian?:




EMERGENCY CONTACT INFORMATION

If we need to contact someone on your behalf, who should we call?

First Name:
Last Name:
Primary Phone:
Secondary Phone:
Email:



BENEFICIARY INFORMATION

Cape CARES provides emergency medical and evacuation insurance, please designate a beneficiary.

Beneficiary Name:
Beneficiary Phone:




PREVIOUS VOLUNTEER AND/OR INTERNATIONAL EXPERIENCE


Tell us about any medical, dental, mission volunteer experiences and/or international experiences.





TRIP AVAILABILITY
Please select your top three choices.

First choice:
Second choice:
Third choice:




PERSONAL STATEMENT


VOLUNTEER AGREEMENT

Download and read the Volunteer Agreement prior to submitting your application.

By submitting this Form you confirm that you have read and agree to the Terms and Conditions of the Volunteer Agreement.



Please follow the instructions after clicking on the SUBMIT APPLICATION button.




Cape CARES is an independent, nonprofit humanitarian organization. It is unaffiliated with and not a subsidiary of any other organization.