Acknowledgement of Risk Form

This ACKNOWLEDGEMENT OF RISK, WAIVER OF CLAIMS AND HOLD HARMLESS AGREEMENT (the "Release") is made by and between __________________________________ (the "Participant") residing at ______________________________________________, and the PARISH OF _____________________ Episcopal Church with its principle place of business at _____________________________________ (church address), Massachusetts.

In consideration of her/his participation in the ____________________, between ________ to ______ 20__ (or close to), and in full knowledge that international travel and work project may involve significant risks, including without limitation loss of or damage to property, personnel injury or death, the Participant agrees and covenants, now and forever, to waive on behalf of himself/herself and any heirs, estates, executors or executrixes, any claim, suit, demand, action at law, or in equity against the Parish of __________, the Diocese of Massachusetts, the Diocese of ___________ (host country) or any of their trustees, officers, directors, employees, contractors or agents (hereinafter individually and collectively called ________________), for or on account of any personnel injury, loss of health, death, loss of property, inconvenience, delay or any other damage sustained by him/her directly or indirectly arising from or relating to her/his participation in this trip.

The Participant also agrees and covenants, now and forever, on behalf of himself/herself and any heirs, estates, executors or executrixes, to hold the _________________ (collective name) harmless against any and all liabilities and expenses and reasonable attorneys fees that the _______________ (collective name) may incur in respect of any claim, suit, demand or cause of action, either actual or threatened brought in any jurisdiction in violation of the covenants made in the previous paragraph.

Any of the _____________ (project name) not party to this Release shall be intended third party beneficiaries hereof and shall have standing to raise any defense or bring claim under this Release in their own names.

The Parties intend that this Release be executed as a seal instrument under seal and that it be governed by the laws of the Commonwealth of Massachusetts, exclusive of choice of law provisions. Any action with regard to this contract shall be brought only within a state or federal court of competent jurisdiction that is located within the Commonwealth of Massachusetts.

The provisions of this Release shall be severable, and in the event that any provision or provisions hereof are invalidated, struck or reformed, the remaining provisions hereof shall continue in full force and effect.

The Release reflects the full and complete agreement of the parties as to the subject matter hereof any may not be modified except in writing.

Signature of Participant: _____________________________ Date signed: _______

Print Name: ______________________________

Witnessed by: _____________________________ Date signed: ___________

(or Legal Guardian if appropriate)

Print Name: _____________________________

Parish Church of __________________ (parish designee such as the Rector):

By: ___________________________ Date signed: _____________________

Mission Project Name

Dates X – Y, 200Z

Permission to Participate Form for High School Students

Please return this form and a deposit for $250.00(*) no later than ______________ to your Parish coordinator. Checks should be made payable to your Church.

I/We give our daughter/son permission to join the collaborative _____________ team, being co-sponsored by our parish, _____________________.

This permission form confirms that the leaders of the _______________ team can proceed with purchasing an airline ticket and making all other arrangements for our child to attend.

Participants Name: ______________________________________________

Participants Passport Name: ______________________________________________

Signature of Participant: __________________________________________

Parent(s) Name(s): _____________________________________________________________

Signature of Parent(s): ___________________________________________________________

Date Signed: __________________

Primary Mailing Address for Parent/Participant:

Street: _______________________________ City: _________________

(H) Phone: ______________________ Zip Code: __________

(W or Cell) Phone: ___________________

Parental Consent / Release from Liability

I/We, the undersigned parent(s) or guardian(s) of ____________________________ , a minor, consent to him/her participating in a voluntary mission trip to ___________ organized by _______________ Church of __________ scheduled for _______, 200_ (mission trip). I/We release and discharge each of the participating churches, their officers, employees and all organizers of the mission trip from all claims, damages, or losses of any nature that: 1) I/we may have or acquire as the parent(s) or guardian(s) of the above-named minor from him/her voluntary participating in the mission trip; and 2) the above-referenced minor may have arising out of or resulting from his/her participating in the mission trip.

I/We authorize adult participants in the mission trip to act on our behalf in authorizing and consenting to emergency medical care for the above-referenced minor if he/she becomes ill/injured while participating in the voluntary mission trip. This consent may be presented to the appropriate medical emergency medical staff at the time emergency medical care is required. I/We release and discharge the participating churches, their employees, organizers of the mission trip, and adult participants in the mission trip from any claims of any nature that may arise out of the decision to provide emergency medical care.

_______________________________________________________________________________________________

Signature(s) of Parent(s) or Guardian(s)........................ Relationship .......................... Date........

You’ll probably want everyone in your group to complete the following form before departure. It is advisable that you take a copy with you and leave another on file at your church. Be mindful that you are asking personal information that should remain confidential unless an emergency situation requires you to use it.

Health Information Sheet

Your name : _____________________________________________________________

Your address: ___________________________________________________________

_________________________________________________________________________

Your home phone: ____________________ cell: _____________________________

Health Insurance Company: Insurance #: ___________________________________

Your Primary Doctor's Name: _____________________________________________

Phone number: ___________________________________________________________

Please list any medications you will be taking with you on the trip:

In case of Emergency:

Please contact: Name: ___________________________________________________

Relationship to you: ____________________________________________________

Phone: ________________________________

Other phone: __________________________

Special Diet Concerns (we need to be aware of):

Any other information we should know before departure?

The following is a SAMPLE letter from a diocesan representative to a church group that inquired about making a service trip to their Central American country. To avoid any confusion about the projects identified in this letter, the content has been generalized. It is offered here ONLY as a sample to give groups that are discerning a possible trip a sense of what to expect and what sorts of projects might be done.

Sample Response Letter from an International Diocesan Representative

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To Whom It May Concern:  

Needless to say, I'm thrilled that you each are considering volunteering your time and talents in our country. The needs are great and the rewards are even greater! I'd be happy to send you some names and email addresses of recent group leaders - they would all be willing to share their experiences and could provide valuable information.

The following gives an overview of some of our current volunteer activities. In addition to the projects listed we are planning on the following: 1) Construct a computer room for St. Andrew's School 2) Interior and exterior painting at St. Peter's Church 3) Build block security fencing at Queen Square School 4) Raise a classroom floor (due to flooding) at St. John's School 5) Construct a walkway for St. Paul's School 6) Exterior painting at St. Paul's Church  

The following is a list of some of our updated projects. We hope to work on all of these (and complete!) in the next twelve months.  
1) We are almost finished building a new church. Currently we are praying for a few additional groups to complete the interior work. St. Philip's is located in a beautiful section of the Baboon Natural Wildlife Sanctuary (actually they are howler monkeys - smile) with lots of outdoor activities available. In addition it’s close to one of our Anglican Schools so those who wanted to could work in the school. There is a wonderful Nature Lodge that we've used in the past - individual cabanas with thatched roofs and great food - that could accommodate your group.  
2) In the southern part of the country we are revitalizing our Anglican community. A missionary priest and his wife from the States (good friends of mine) arrived in March of 2004. It is the first time in over 25 years that a priest has been in residence. Needless to say the faithful (about 18 of them) are thrilled. We want to do two projects here. The first is to continue repairs to the existing Church. The second is to complete the community's first and much needed pre-school.  
3) In the western part of the country we need to finish construction of a multipurpose building which will serve as a Church/canteen/hurricane shelter. We are finding that every school needs a feeding program as more mothers work outside the home, fewer children have anyone to go home to, and poverty levels have increased. For many children the only good meal they get each day is the one served at school. We receive no help from the government in building canteens (not deemed necessary for education) or in procuring the food. This is a terrible burden on the Diocese and a tragedy for many of our students. We really need assistance with this.  
4) In the south, we also need a canteen for our local school.  
5) In the north, our Anglican school has recently received computers from the government. However, until they have a secure room for the lab, they cannot take possession of the computers. We need to build that room as soon as possible so the children can benefit from this wonderful gift.  

I am happy to report that the following projects (on our last year's list) have been completed - thanks to hundreds of dedicated volunteers:
1) The canteen for one of our Anglican schools. Twenty three hungry children are now receiving a nutritious lunch!
2) Another canteen for an Anglican school. Eighty five students are benefiting daily!
3) A computer room will be completed by the beginning of this next school year!
4) Repairs to a rectory.
5) Refurbishing of a Center that serves as a school auditorium, Cathedral parish hall, and community center.  

The following projects still need to be done:
1) Drainage system, landscaping and fencing.
2) New windows, burglar bars and interior painting.  

We are definitely making progress but there is still so much to be done!!!

Most groups find it important to agree to a code of conduct prior to departure. This will be particularly useful with youth groups. This sample was drawn from a code of conduct used by a group of parishes that worked together to travel to Belize. You may want to customize a code to your particular circumstances, but this sample will give you a good place to start.

Sample Code of Conduct

The following information is a list of frequently asked questions provided by ERD to groups planning to travel to El Salvador. Although it is country specific, some of the questions are applicable to other countries. Also, at the end of the document is a good list for individuals to consider when planning and packing for their trip. Please note that, although ERD has discontinued its volunteer trips to El Salvador, much of the information is still current as of 2008.

Episcopal Relief and Development FAQs

Solidarity El Salvador - General Information

El Salvador is a small, developing country in Central America that shares borders with Guatemala to the west and Honduras to the east. ERD sends volunteers to El Salvador to work in its national reconstruction effort which is a response to the 2001 earthquakes. Volunteers stay at the diocesan guest house in the capital of San Salvador and travel to work and visit sites from there. Some travel could be as long as 3 hours one way. You will arrive into El Salvador via the international airport in San Salvador (airport code SAL.)

El Salvador is tropical with a rainy season that lasts from May to October. It will rain most nights during this time, but rarely does it rain all day. The dry season, from November to April, leaves the country dusty. This could affect people with respiratory problems. The average temperature is about 88 degrees Fahrenheit year-round.

The Anglican/Episcopal Church of El Salvador has about 20,000 members in 12 churches and several missions. The church works with communities to improve their well-being. The mission of the church is to follow the path of Jesus with love and tenderness, to continue solidarity with marginalized members of society, and to provide a commitment of faith, hope, and love. The church has many programs providing health care, earthquake reconstruction, schools, theological education, and human rights. The priority of the church is to plant and cultivate a culture of peace and justice through Jesus Christ.

Frequently Asked Questions

What do volunteers do in El Salvador?
The bulk of a volunteer’s time is spent working in one of ERD´s projects. Most volunteer groups perform work related to the building of the ERD-funded housing communities. The work is non-technical in nature and if it requires training, it will be provided at the work site. Most work is somewhat physically strenuous (clearing brush, excavation, leveling, etc…) Tasks are assigned by the Salvadoran project staff when the volunteer group arrives according to the needs of the projects and safety and logistical considerations. For this reason, ERD does not offer groups a choice of the work they will do. We ask that you put yourself at the disposition of the needs of the projects.

There are also planned recreational activities including a trip to the beach and to the craft market.

How does this help?
Principally, you will be building relationships with members of the Salvadoran Episcopal community. You will meet and work with Salvadorans and will get to know a little bit about the problems facing El Salvador and the poor in other countries in general. Volunteers will learn from a limited cross-cultural exchange ( ERD volunteer trips are not a full cultural immersion.) Visitors also help the local economy by bringing in tourism revenue. More than anything, having North Americans visit El Salvador brings faces to go with the funds that ERD provides. The fact that donors care enough to visit brings hope to the people ERD serves.

To a lesser extent, volunteer and beneficiary labor comprises a significant portion of the enormous amount of labor that goes into ERD projects in El Salvador. Your gift of your time will help us economize on labor and reach more people given our finite economic resources.

What are the accommodations like?
You will stay at either or both of the diocesan residences located at San Juan Evangelista Church in San Salvador and at the El Maizal ERD project site. Accommodations will be divided into separate facilities for men and women with a common meeting/dining area. Accommodations are basic with bunk beds and cold showers. Episcopal Church rules require adult and youth volunteers to be lodged in separate rooms. We appreciate and rely on your attention to this guideline for your protection.

How do I arrange the pilgrimage?
The first thing you need to do is to identify the people who will compose your group. You need a minimum of five people in your group but no more than twelve. Talk to your group members and decide when you are able to make a one-week trip. Contact ERD's volunteer coordinator at 1-800-334-7626 ext. 6105 to schedule your trip. In order to schedule your trip, ERD requires a $200 per group non-refundable deposit that should be sent to Episcopal Relief and Development- Volunteer Coordinator, 815 Second Ave., New York, NY 10017. Your group will need to arrange air transportation.

What is the minimum age?
The minimum age for volunteers unaccompanied by a parent is 14. Groups must have at least 1 adult chaperone per 5 minors (youths.)

What is the group size?
The maximum is 12 and the minimum is 5 people in a group. We cannot accept groups that are larger than 12 or smaller than 5 because of cost-effectiveness and accommodations.

Is there a maximum age for volunteers?
There is no maximum age, however please be advised that volunteer work is physical in nature, and some of the travel includes arduous drives on bumpy, dusty roads.

What is the cost of the program?
The breakdown of costs is as follows:

Please note that only the initial trip deposit is paid to ERD.

What currency is used in El Salvador?
As of 2001, the official currency of El Salvador is the US Dollar, so no currency exchange is necessary when traveling to the country. ERD recommends bringing cash in denominations of no greater than $20 because often merchants are suspicious of large bills and/or do not have change for them.

How will I communicate in El Salvador?
The language of El Salvador is Spanish. Groups are received by and accompanied during the week by an interpreter.

What kind of food will be served?
Food will be prepared for you at you lodging. You will be served a simple Salvadoran breakfast, lunch, and dinner. The meals are Salvadoran cuisine prepared by staff trained to cook for delicate North American stomachs . If you decide to eat out for any meal, please let the staff know a day in advance so that they may plan ahead. Boxed lunches are available for days when volunteers are not at the lodging during lunch time.

Will we have the opportunity to worship?
Yes. We recommend getting together before your trip to pray together and meet as a group. ERD recommends that volunteers hold a group meeting every day to reflect on what they’ve experienced. ERD will provide you with a copy of an example Compline service. There may also be opportunities to attend Eucharist or other worship services and bible meetings in the Salvadoran community. Some volunteers choose not to participate in worship.

Can we drink the water?
NO! You will be provided with purified water both at your lodging and at your work site. We recommend that you use it to brush your teeth as well. Please do not give away your water. The people you will meet have their own source of water. We cannot provide water for all of El Salvador.

Should we bring our own bed linens and towels?
No, they will be provided for you.

Should we bring our own toiletries?
Yes. Note: El Salvador uses 110V 60Hz electricity just as in the US, so you can bring and use electrical appliances (ie blow-dryer, electric shaver, etc…) You should be aware however that power outages are frequent.

¿Que hora es?
El Salvador is on Central Standard Time during North American Daylight Savings time and on Mountain Standard Time the rest of the year.

What do I need upon arrival in El Salvador?
US passport holders must have a valid passport. US passport holders will pay $10 for their tourist visa in the immigration area. If anyone in your group has other than a U.S. passport, they should call a Salvadoran consulate and follow their instructions for obtaining a visa prior to travel. If you do not already have a passport, allow plenty of time to obtain one before the trip as that process can take as long as 4 months. ERD requires that you send us copies of all group members' passports and suggests you carry a copy of your passport as well.Passport theft is a danger. Report a lost or stolen passport immediately. After going through customs, you will be met at the airport by a church employee with your group leader’s name.

Do I need any immunizations?
We recommend that you follow the Center for Disease Control’s advice. They recommend vaccinations for diptheria/tetanus, Hepatitus A and B, typhoid, rabies, and malarial prophylaxis. Depending on your physician’s advice and health insurance, these may cost up to $300.

Can we bring donations?
Consider making your gifts to El Salvador through ERD instead of directly. ERD’s professional staff works hard to determine the best way to help the people of El Salvador. We focus our efforts on social and economic development, and pride ourselves on managing your donations in the most efficient manner possible. ERD provides the best value and most trustworthy destination for your donation.

The Diocese of El Salvador does accept certain kinds of in-kind donations including school supplies, children’s books, and over-the-counter medicines. Medicines should be sealed and accompanied by a letter from your group or church stating that they are a donation for the church. All donations should include an inventory, and should be given to the Salvadoran program staff. Please provide an inventory copy to the ERD office as well. Please do not give gifts of any kind directly to individuals in or around ERD projects.

Where do I send my paperwork?
You will send your non-refundable deposit (due at time of initial trip scheduling,) passport copies, registration forms, and your deposit check to:

Volunteer Coordinator
Episcopal Relief and Development
815 Second Avenue, 2 nd Floor
New York , NY 10017

The deposit is $200 per group. This money will go to the El Salvador program. It will not be applied to your expenses, which you will pay directly to the church in El Salvador. The deposit to ERD guarantees your agreed-upon trip dates.

What should I pack?

NOTE: CLOTHES SHOULD BE COOL AND LOOSE FITTING
There are cultural considerations related to dress. Salvadorans do not wear shorts except when recreating. Women wearing shorts or tight-fitting and/or revealing clothing in public might receive unwanted attention. Salvadoran men wear long pants and women wear either pants or a skirt. Following their example is a good way to avoid possibly uncomfortable situations and to show respect for and humility in their culture.

Suggested packing list:
Boots or sneakers (that are sturdy and water repellent)
Work gloves
Light pants for evening wear.
T-shirts/long sleeve shirts
Lightweight skirt or sundresses for evening wear.
Tank tops (beware that the sun in the tropics is very intense. Use lots of sunscreen).
Sweat socks
Underwear
Bathing suit
Hat with broad brim. (Baseball caps do not protect your ears and neck)
Sweat band/bandana
Work Gloves
Rain suit/Poncho
Water bottle (Plastic disposable water bottles available at stores)
Combination type padlock (for lockers in San Salvador)
Sun Glasses with UV protection (Tropical sunshine can injure your eyes)
Medications (with copy of prescriptions)
Immodium AD/Pepto Bismol/Cipro (pill form)
Alcohol wipes
Liquid hand wash with disinfectant
Sunscreen SPF 35
Bug repellent with at least 33% DEET
Band Aids (continued on reverse)
Bacitracin/Neosporin or other antibiotic ointment
Small flashlight with extra batteries
Shower shoes
Camera & film & spare batteries (film is expensive)
Regular toiletries
Bar soap
Tylenol/Aspirin

Budgeting Advice

To start … you already have a pretty good sense of regular costs … airfare, local transportation, room & board, and spending money. Work up a spreadsheet with those details.

Think through all that you’ll do when you are in your host country … where you’ll go, who and what will help you get there, will you eat while there, will that be included in packaged fees, etc. … think in terms of a flow chart (hint: you’ve probably done this before planning a family vacation). Also, make sure you engage with your host. Often, there is a host representative that will have a good handle on some of your trip questions. That person may even have a substantive list of travel costs based on previous group experiences.

Now that you’ve completed a draft of your budget with all the obvious costs, think about the hidden costs and contingencies?

Hidden Costs:

Some Travel Advice for ALL Travelers

GENERAL EXPENSES

Airfare (averages for budgeting purposes as of Spring 2008)

*Keep in mind that airfare can vary significantly with group packages, current economic conditions, and time of year.

Project fees should be considered as a group, but in many cases groups may choose to divide the responsibility for raising the funds across the team. For example, a project might cost $2500 for supplies and 10 people are planning to go. The group may decide that each person is responsible for raising $250 toward the project cost. Groups will undoubtedly work together on fundraising, but this breakdown will give them some barometer of what to expect from each other in terms of participation in those fundraising efforts.

Groups should plan on $40 to $50 per volunteer per day to cover your local transportation, meals, lodging, and water. When figuring transportation other than airfare, remember that you need to get to and from the airport. You may have local support for transportation, but be mindful of the potential expense if you do not.

ERD recommends about $150 per volunteer in additional spending money while in country. Also, keep in mind that many countries have a passport tax (for US passport holders) of $10 or $20 payable upon entering and $20 - $30 upon exiting the country. It is recommended that group leaders determine the specifics of any passport tax and hold sufficient funds to cover the exit of all volunteers.

Travel insurance is highly recommended, since most U.S. health insurance plans will not cover treatment abroad or medical evacuation. Coverage can cost as little as $6/day and typically includes a death and dismemberment benefit, luggage loss protection, and most importantly medical evacuation to your home country in the case of an emergency. There are a number of carriers for travel insurance. You may be able to obtain coverage through Church Pension Group at 1-800-223-6602. You may also want to try www.insuremytrip.com on the internet.

Leaders should determine the appropriate currency for a group’s destination. It is recommended that volunteers carry small denominations ($20 or less). Large bills can be an invitation for theft and merchants are often suspicious of large bills and/or do not have sufficient change.

You are encouraged to accept the hospitality of your hosts and sample the cuisine of the region. Note, however, that in certain circumstances and regions you need to be wise while being a good guest. Be careful of fresh foods that you are unsure about their origin or whether or not they are clean. Many people traveling in the countryside of poorer nations tend to carry pepto bismol tablets and acidophilus supplements. Both can help limit any stomach upset and can be used as a prophylactic (e.g. 1 pepto tablet per day; 1 acidophilus caplet before each meal).

One of the key contributors of stomach upset is water. In most instances, you will be provided with purified water which you should consume regularly to prevent dehydration. In many cases, it will be recommended that you purified water to brush your teeth as well. It is often a good idea to carry a bottle of tablets (Potable Aqua) for making water drinkable. It’s not the best tasting, but beats the stomachache that follows a drink of problem water.

You are advised to carry a copy of your passport.Passport theft is a danger. Report a lost or stolen passport immediately. Many groups find it helpful to have a leader be responsible for copies of everyone’s passport. It’s also recommended that you leave a copy of your passport with someone at home in the U.S.

Yes, you will need immunizations. It is recommended that you review the advice of the Center for Disease Control (http://www.cdc.gov/travel/). Depending on your physician’s advice and health insurance, immunizations and medications may cost up to $300. Be aware that many immunizations require time, so DO NOT wait until the week before your trip to schedule your appointment with your primary care physician. Consider seeking immunizations three to six months prior to your departure.

PACKING

NOTE: CLOTHES SHOULD BE COOL AND LOOSE FITTING
There are cultural considerations related to dress. In many countries, for example, it is not acceptable to wear shorts or sleeveless tops except for specific times such as recreating. Also, be aware that in many countries, women wearing shorts or tight-fitting and/or revealing clothing in public might be considered disrespectful and/or receive unwanted attention.

Suggested packing list for most trips:
Boots or sneakers (that are sturdy and water repellent)
Work gloves
Light pants for evening wear.
T-shirts/long sleeve shirts
Lightweight skirt or sundresses for evening wear.
Tank tops (beware that the sun in the tropics is very intense. Use lots of sunscreen).
Sweat socks
Underwear
Bathing suit
Hat with broad brim. (Baseball caps do not protect your ears and neck)
Sweat band/bandana
Rain suit/Poncho
Water bottle (Plastic disposable water bottles available at stores)
Sun Glasses with UV protection (Tropical sunshine can injure your eyes)
Medications (with copy of prescriptions)
Immodium AD/Pepto Bismol/active culture Acidophilus/Cipro (pill form)
Alcohol wipes
Liquid hand wash with disinfectant
Sunscreen SPF 35
Bug repellent with at least 33% DEET (remember, mosquitoes carry diseases)
Band Aids (continued on reverse)
Bacitracin/Neosporin or other antibiotic ointment
Small flashlight with extra batteries
Shower shoes (e.g. flip flops)
Camera & film & spare batteries (film is expensive)
Regular toiletries (including a small roll of TP and a pack of tissue)
Bar soap
Tylenol/Aspirin

This document is provided by Episcopal Relief & Development to groups traveling to El Salvador. For the most part, the guidelines are applicable to just about any other region in the world. As such, they offer some useful advice for travelers preparing to depart from the United States.

Guidelines for Volunteers