Volunteer Forms

Application, Photo Release & Liability Waiver Form

Volunteer Health Reference Form

Kids Against Hunger Volunteer Form

Kids Against Hunger Packing Event Form

 

Intern

Internship Application Form

 

Mission Teams

All medical volunteers must complete the following:

  • Complete the Online Application, Photo Release & Liability Waiver Form.  Please be sure to fill out the application completely and submit your form; a confirmation will appear after you have clicked the submit button.
  • Send in a copy of your Immunization Records and a Medical Release from your physician.

As soon as you have completed the online volunteer form you will need to send copies of the following as soon as possible:

  • RN, MD or other professional license (http://www.nursing.ohio.gov/Verification.htm)
  • List of Current Privileges – MD’s only
  • Certifications for PALS, BLS, ACLS, etc.
  • All diplomas received
  • Passports
  • Driver’s License

 

Tips for Fundraising

Fundraising Guidelines (pdf)
Raising Funds – Suggestions (pdf)

 

Guidelines for Images

Guidelines for Images (pdf)

 

Travel Information

Check here for Travel Guide
Medical Mission Team Volunteer Checklist (pdf)

For up to date information on travel to foreign countries, including current travel advisories, please check www.state.gov/travel.  Additional information on a particular country can be found at the US Embassy site in that country.  Links to the US Embassy around the world can be located at usembassy.state.gov.

You may want to check on the protocols for handling travelers to and from SARS infected areas. You may want to check with the airlines and/or the Embassy of the country you intend to travel to enter or transit. Locate the embassy web address at usembassy.state.gov. American citizens may also contact the Department of States toll-free at (888) 407-4747, or if calling from overseas, (317) 472-2328, for information.

For additional you can contact the Central for Disease Control at www.cdc.gov for immunizations and other information.

Helpful websites:
www.missionaryhealth.net

 

The Children’s Medical Rehabilitation Program

Thank you for your interest in the Children’s Medical Rehabilitation Program. Below is an application for the Children’s Medical Rehabilitation Program. Please read the application carefully. If you have any questions, please let us know. After you have filled out the application return it to our offices.

Although IMPACT WITH HOPE  will endeavor to locate sources of funding to assist you in providing medical treatment for your child, each applicant must be prepared to pay a non-refundable application fee of $25.00 USD, along with airfare to the United States.

Please be aware, all applications are reviewed and processed by IMPACT WITH HOPE as well as medical institutions and health care professionals.  All documents must be completed and returned to our office before any final determination will be made.  See below applications.

Children’s Medical Rehabilitation Program Online Application Form
Online Children’s LightHouse Guidelines and Rules Online Form
Parents Authorization for Treatment Online Form
Power Of Attorney Form
Physician’s Authorization For Treatment Online Form

Sincerely, 
Linda A. Greene RN, PhD
, President, IMPACT WITH HOPE