Volunteer Information Form

In addition to filling out the form below, please download, print and sign our consent forms, and email to info@handsupforhaiti.org or mail back to:

Hands Up for Haiti
PO Box 913 
Mt. Kisco, NY 10549

Please enter Month and Day from the Upcoming Trips list on our website, or Open if undecided

Even if you are a returning volunteer, please update your information below.

Smaller airlines require this information.

Dietary Preferences/Restrictions

Our teams are often dependent on our local hosts for meal preparation and we cannot guarantee that special dietary needs can be met and you may have to bring pre-made or packaged food. Every effort will be made to safeguard the food and water served for our group.

Professional Information

Please describe your area of specialty.

Other than your professional skills, please describe any skills or talents which might be useful on this team:

Skills and Language

Do you have:

Please list any computer-based skills.
Please list and photo/video-based skills.

Medical Information and Emergency Contacts

Traveling to and working in a resource poor country like Haiti can be dangerous to those individuals with serious health issues. Having a chronic medical condition would not disqualify an individual from participating in the program, however, each applicant is considered on a case by case basis. It is ultimately up to the team leader to decide if an individual can be safely accommodated on a particular mission. Please be honest with your team leaders regarding any potential medical emergencies that could arise. All health information will be kept confidential by the team leader.

MEDICATIONS: Obtaining personal medications (that we do not bring with our team) is not possible as there are no retail pharmacies in Cap Haitien. All volunteers must be responsible for bringing any personal or emergency medications in ample supply.

PSYCHOLOGICAL HEALTH: Traveling to and working in Haiti can be a very stressful experience. Please inform your team leader of any psychological or emotional conditions (such as anxiety disorders, depression, panic attacks, mood disorders) that may affect your performance as a team member on this mission (all information will be kept confidential).

Emergency Information

Travel Health Insurance

Emergency contact #1

Emergency contact #2