Additional Form for 

Volunteers with Special Needs

Sending branch:    SCI-Germany (SCI-D)		

Please complete this form in English.
Dear Volunteer,
In order that you enjoy your experience in an international workcamp and benefit as much as possible from it, it is very important to inform both SCI and the project partners in advance about any special needs you might have. This will help the hosting project to meet your requirements and thus ensure that you will be able to participate as independently and self-confidently as possible in the daily life of the camp. 

We will treat the information in this form confidential. This form will be send to the hosting SCI-branch ir partner organisation, who will forward it to the project, where the camp takes place and to the campleaders. 

Below you will find a list of questions which can help us to understand your special needs. Please answer the following questions where you feel they apply to your situation and to your needs. Feel free to add any additional useful information that you think necessary for us to know. When you have completed the form, send it back via email to info@sci-d.de. Thank you!

Volunteer Information

							 female  male	            /              /19    
Surname				First Name		Sex			Date of birth (day, month, year)

Address 									Country  

Phone				 Mobile 					E-mail  

Contact PERSON IN CASE OF EMERGENCY

Surname				First name		Your relation to this person (mother, friend etc.,)

Address									Country  

Phone 				Mobile 					E-mail  

Family Doctor (name and phone number) 

Questionaire for volunteers with special needs

1.	Please, describe what kind of special needs/disability you have: 

2.	What do you need in order to take part to a camp (e.g.: rooms with wheelchair accessibility, electricity to recharge batteries,  fridge to store medicines …)?

3.	Do you need the camp to be close to a hospital, or else chemist’s shop?

4.	Do you expect/need special assistance from campleaders or other volunteers of the camp (e.g. for using toilet, shower, personal hygiene)? If yes, do you have difficulties to accept help from strangers/people you don’t know well? [In case you bring along an assistence person, please write here only what support you might need or expect from the rest of the camp group or the project] 

5.	Have you ever travelled abroad? If so, what kind of problems did you encounter?

6.	In case you cannot take part in the everyday workcamp activities, in which way can you support the group (cooking, playing music, making people laugh …)?

7.	Are you capable to spend most of the day outside the accommodation, under different weather conditions?

8.	Please tell us about any special problem which may happen outside home: 

9.	For volunteers with a wheelchair: can you use the passenger’s seat in the car or do you have to sit constantly on the wheelchair?

Please note:
•	In case you bring a person responsible for your assistance, she/he needs to apply for the camp with an extra application;
•	In case your life depends on medicine which you have to take on a daily basis, we ask you to bring a medical report from your doctor in case of emergency; 
•	Also we advice you, to take enough of the medicine you need during your stay abroud along. We cannot assure you, that you will find the medecine you need in a foreign country easily; 
•	IMPORTANT: SCI-insurance is not covering costs for medical treatments or medecine for any illnesses that occurred before the workcamp. Please get in touch with your own health insurance to make sure, that you are insured with them during your workcamp! More info on SCI-insurance you find here: www.sciint.org/insurance
•	Never take for granted that persons in the camp know what needs you might have. The more detailed information you can provide us with, the better we are able to check whether or not the project partners are able to meet your needs and expectations