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Program Fees
Fee for 1 week session is $380 per person
Fee for a 3-day weekend is $220 per person
Fees include all meals, lodging, group equipment, work site materials, and
programming options.
Week long programs run Sunday 3:00 PM through Saturday morning.
Three day weekend programs run Friday morning through Sunday afternoon.
Alternate Fee Programs
There are two other package options that require more work on the part of the
volunteers in the groups.
1. If you wish to provide your own cook, food, and materials for the jobs you
want to work, the cost is $25 per day per person.
2. If CMO provides the food and cooking and the group prefers to purchase the
materials for the building project while on the mission trip, the cost is $50 per person per day.
Group Payment and Application
A $500 group application fee is required upon submission of the group application.
The fee includes one group leader fee and covers operations and registration
costs. This fee is transferable and refundable only if no space is available. The
final balance for the trip is due 15 days before the session. If not received by
this time, the session will be canceled.
Fees are payable to:
Cumberland Mountain Outreach
102 East Third St.
Beattyville, KY 41311
606-464-8134
E-mail: fellerc@bellsouth.net
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CMO Emergency Contact and Medical Information for a Minor
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Parent’s/Guardian’s Name
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Home Phone
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Home Phone
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Work Phone
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Address
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Address
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City, ST ZIP Code
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City, ST ZIP Code
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Alternative Emergency Contacts
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Primary Emergency Contact
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Secondary Emergency Contact
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Home Phone
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Address
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Address
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City, ST ZIP Code
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Medical Information
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Physician’s Name
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Phone Number
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Insurance Company
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Policy Number
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Allergies/Special Health Considerations
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I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.
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Parent’s/Guardian’s Signature
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Date
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I give permission for my child to participate in all Cumberland Mountain Outreach (CMO) activities. I release CMO and individuals from liability in case of accident during activities related to CMO, as long as normal safety procedures have been taken.
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Parent’s/Guardian’s Signature
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CMO Emergency Contact and Medical Information for Adults
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Current Medications:
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Any known medical conditions:
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Emergency Contacts
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Primary Emergency Contact
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Secondary Emergency Contact
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Home Phone
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Work Phone
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Home Phone
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Work Phone
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Address
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Address
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City, ST ZIP Code
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City, ST ZIP Code
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Medical Information
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Physician’s Name
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Phone Number
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Insurance Company
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Policy Number
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Allergies/Special Health Considerations
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I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for myself and waive my right to informed consent of treatment. This waiver applies only in the event that I am unconscious and none of my emergency contacts can be reached in the case of an emergency.
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Signature
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I release CMO and individuals from liability in case of accident during activities related to CMO. I understand that I am completely responsible for my safety and payment of medical bills should accident occur.
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Signature
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