HCRM - Petionville, Haiti

Volunteer Application

Ayiti Enfants Sauver Mission

Rue Pelerin 9, Petion-ville, Haiti
011 509 445 1961 or 011 509 419 0480 or 011 509 449 0948

Contact Us

** Please use the TAB button to move between fields. **

General Information

Application date:

Name (full name):

Date of Birth:

Marital status:

single married divorced remarried

Date of Marriage:
*Home Address:
Phone Number:
*Email address:

Volunteer Information
Length of Time You Would Like to Volunteer:
Dates of Service:
Have You Have Any Experience Working With Children:
If Yes, Please Describe:
Please Describe Any Previous Mission Field Experience:
Why HCRM?:
Please Describe Any Skills That You Feel Will Be of Benefit to HCRM During Your Time Here:

Religious Information

Religion/Denomination:
Are you active in a Church (yes/no):
Name of Church:
Pastor's name:
Pastor's Phone Number:
Pastor's Email address:

Which of the following terms best describes your present religious experience (check all that apply)?

born-again	attend church regularly
evangelical	attend Sunday school
do not attend a church at this time	non-traditional church

Describe your personal relationship with Jesus Christ:

Reference Information (required)

Please provide name, phone number, addresses, emails (if available) for four references including one member of your immediate family.

Name	Phone Number	Address	Email

Emergency Contact Information

Name	Phone Number	Address	Email

I understand that HCRM is a faith mission and each volunteer must raise their own support for airline fare, room and board, personal items, spending money, and any other costs that might arise during their stay in Haiti. Each volunteer must also have health insurance that will cover them while in Haiti or be responsible for any medical bills they might incur while volunteering at HCRM.

Statement of Faith and Purpose

The board of Ayiti Enfants Sauver Mission (HCRM) is dedicated to seeking and to finding stable, Christian homes for the children. The board of HCRM is committed not only to the children, but to their birth parents, to find homes where the children will be taught the love and the truth of Jesus Christ.

We believe the Bible is the word of God, the absolute authority and without error, that there is one God, who exists eternally in three persons: the Father, the Son, and the Holy Spirit. We believe that Jesus Christ is the eternal Son of God, who through His perfect life and sacrificial death paid the price for the sins of all who will trust in Him, alone, for salvation. We believe that all aspects of our lives are to be lived to the glory of God under the Lordship of Jesus Christ.


Do you agree with the above statement of faith and purpose?	yes	no

Signature:

Date:

Initials:

Please print a copy of this
application before submitting.

Please send signed hard copy to:

HCRM c/o
Pastor Jean Fritz and Mrs. Mireille Nicolas
Lynx Air International
PO Box 407139
Fort Lauderdale, FL 33340-7139