Dear Prospective Applicant:

Thank you for your interest in Cape CARES, Central American Relief Efforts. We welcome you and hope you will join us in our efforts to provide free medical and dental care to the underserved in Honduras. Please read the information and instructions below carefully and the Cape CARES Volunteer Agreement Form before submitting your application.

Application and Documentation Requirements

Please complete and submit our application online or print a hard copy, complete and mail it to:

 

Cape CARES

P.O. Box 1049

East Orleans, MA 02643

 

Be sure to indicate the week(s) you want to serve. If space is available for the indicated week(s), we will notify you and reserve that space for 30 days. Within those 30 days, we must receive the documents indicated below:

• the Volunteer Agreement, signed and dated (please click HERE to view and print the Volunteer Agreement)
• copy of passport photo page
• copy of professional license and diploma (only if you are a physician or dentist)
• copy of a valid driver's license (only if you wish to help drive in Honduras)
• in-country fee of $550 to help defray our expenses for your housing, meals, transportation, and mission travel insurance for one week.  Please make check payable to Cape CARES. (Though the fee is required, you may consider it a donation for tax purposes.)
• We welcome and appreciate any donations you receive to help defray Cape CARES' cost of medications and supplies.

All materials indicated above must be received at least two months prior to your departure for Honduras.

If you submit your application within two months of the departure date, you must provide us with your documentation and fee within 5 days after we notify you that there is space for the requested week.

Matching Gifts

Your volunteer fee and airfare for travel to and from Honduras are considered charitable contributions for tax purposes. These amounts are eligible, therefore, to be matched by your employer if you have a Matching Gifts program where you work. Please visit your Personnel or Human Resources Department and obtain the required Matching Gift form.

Airline Tickets

You are responsible for the cost of your airfare. Airline tickets may be purchased one of two ways (see below). Please consult with your team leader regarding purchase of tickets prior to making your reservation.

1. You make your own reservation and remit payment to airline. After securing ticket, you must notify the Cape CARES administrator of the dates of travel, airline, flight times, and flight #'s.  If you would like to receive a letter from Cape CARES acknowledging your volunteer fee and airfare as charitable contributions, you must submit to the Cape CARES office your flight itinerary with the airfare amount indicated.

 

2. Your team leader may opt to reserve and submit payment for a block of tickets for the group. As a volunteer, you have the option of being included in that "block" or making your own reservation and purchasing your own ticket. You are responsible for telling the team leader whether or not to include you in the group reservation. If you choose to be included, you must send a check for your airfare, made payable to Cape CARES, to the administrator by the date given to you by your team leader.

Regardless of how your ticket is purchased, it is in your name. (You may consider your airfare expense a donation for tax purposes.)

If either you or Cape CARES cancels your trip for any reason, it is your responsibility to work with the airline for reimbursement or to transfer to another destination. Cape CARES assumes no responsibility, financial, or otherwise, for ticket charges when a trip is canceled. We strongly recommend purchasing travel insurance at the time you purchase your ticket.

Before and After Your Week with Cape CARES

Your Cape CARES trip begins and ends on the dates provided for your week. If you choose to arrive in Honduras before the start of the volunteer week and/or to stay in Honduras for any length of time beyond the end-of-trip date, expenses incurred during these time periods are your responsibility. These include, but are not limited to, accommodations, meals, and transportation. Be sure to check trip dates, found on the Trip Dates page, before making your air reservations.

Fee Refund Policy due to Trip Cancellation

• If you cancel your trip up to four months prior to departure, we will refund 100% of your fee. If you cancel within four months of the departure date, we will refund your fee minus administrative expenses incurred by Cape CARES or you may apply your fee to any Cape CARES trip scheduled during the following 12 months.
• If Cape CARES cancels the trip for which you are scheduled, we will refund 100% of the fee or you may apply your fee to any Cape CARES trip scheduled during the following 12 months.

If you have any questions regarding the application process, please contact our administrator at (508) 631-4848 or by email at admin@capecares.org.

Once again, we thank you for your interest in bringing much-needed medical and dental care to our friends in Honduras.

Sincerely,

Cape CARES Board of Directors

A. CONTACT INFORMATION

First Name:    Last Name: 

Street Address 1:  

Street Address 2:  

Town/City:     State: AK AL AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY     Zip Code: 

Country:

Home Phone:    Cell Phone:    Work Phone:

eMail Address 1:    eMail Address 2:

Date of Birth (mm/dd/yyyy):  

B. AVAILABILITY - TRIP DATES AND SITES (if submitting application via US Mail, please select trip dates and sites based on the trip schedule found on the Cape CARES' website)

1st Choice: Los Encinitos February 3-10, 2012 El Algodonal February 12-19, 2012 San Marcos March 2-9, 2012 Los Encinitos May 5-12, 2012 San Marcos June 13-20, 2012 San Marcos October 21-28, 2012 Los Encinitos November 3-10, 2012 Los Encinitos February 4-10, 2013

2nd Choice: Los Encinitos February 3-10, 2012 El Algodonal February 12-19, 2012 San Marcos March 2-9, 2012 Los Encinitos May 5-12, 2012 San Marcos June 13-20, 2012 San Marcos October 21-28, 2012 Los Encinitos November 3-10, 2012 Los Encinitos February 4-10, 2013

3rd Choice: Los Encinitos February 3-10, 2012 El Algodonal February 12-19, 2012 San Marcos March 2-9, 2012 Los Encinitos May 5-12, 2012 San Marcos June 13-20, 2012 San Marcos October 21-28, 2012 Los Encinitos November 3-10, 2012 Los Encinitos February 4-10, 2013

C. EMERGENCY CONTACT INFORMATION

First Name:    Last Name: 

Street Address 1:  

Street Address 2:  

Town/City:     State: AL AL AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY     Zip Code: 

Country:

Home Phone:    Cell Phone:    Work Phone:

eMail Address 1:     eMail Address 2:

Cape CARES purchases Mission Volunteer Evacuation Insurance for all volunteers going to Honduras. This insurance covers you while working at the Cape CARES clinic site in Honduras and when traveling within Honduras to and from the clinic site. It does not cover you while traveling from your home to Honduras, nor from Honduras back home. In order to be included on this policy, you must provide us with the name of your designated beneficiary. Please indicate below your beneficiary and his/her phone number.

Designated Beneficiary:    Phone number:  

D. PREVIOUS VOLUNTEER AND/OR INTERNATIONAL EXPERIENCE - Tell us about any medical.dental mission volunteer experiences and/or internation experiences.

E. PROFESSION/AREA OF EXPERTISE - Please indicate your area of expertise, the number of years you have worked in that area, and the types of settings in which you have worked (e.g., hospital, clinic, school, etc.)

PHYSICIAN:  Area(s) of Expertise 

                 Years of Experience

                 Workplace Setting(s) 

 

NURSE (RN, LPN, or NP):   Area(s) of Expertise

                                   Years of Experience

                                   Workplace Setting(s) 

 

CHIROPRACTOR OR PHYSICAL THERAPIST:   Area(s) of Expertise

                                                                       Years of Experience

                                                                       Workplace Setting(s) 

 

DENTIST:  Area(s) of Expertise

                Years of Experience

                Workplace Setting(s) 

 

DENTAL HYGIENIST (or assistant):  Area(s) of Expertise

                                                  Years of Experience

                                                  Workplace Setting(s) 

 

OPTOMETRIST (or assistant):  Area(s) of Expertise

                                           Years of Experience

                                           Workplace Setting(s) 

 

PHARMACIST:  Area(s) of Expertise

                       Years of Experience

                       Workplace Setting(s) 

 

PUBLIC HEALTH:  Area(s) of Expertise

                            Years of Experience

                            Workplace Setting(s) 

 

OTHER:  Area(s) of Expertise

             Years of Experience

             Workplace Setting(s) 

F. SKILLS - Describe your level of fluency in Spanish. Be sure to indicate when you studied the language, the number of years you studied it, and how capable you consider yourself to serve as a translator. (Participation on a team is not contingent upon ability to speak Spanish.)

Speaking:

Reading:

Writing:  

G. OTHER SKILLS

General Assistant          Carpenter           Plumber           Electrician            Educator

Other

H. Please indicate if you are a vegetarian. Yes   No

SECTION I - PERSONAL STATEMENT - Use the space below to tell us why you want to join a Cape CARES mission to Honduras.