Bethlehem Farm Our Lady of Grace

July 4-10, 2021 Trip Information

Timeline Week At A Glance

Packing List Volunteer Contract*

Hold Harmless Agreement* Health Insurance/Medical Release* Adult Background Check (if 18+)* *To be turned in by May 1, 2021

What is Bethlehem Farm? Bethlehem Farm is a Catholic community in Appalachia that strives to transform lives through serving the local com-munity and teaching sustainability. They host high school and college groups from around the country and enable volunteers to join them in living out the Gospel cornerstones of prayer, community, simplicity and service. When is Our Lady of Grace's Bethlehem Farm trip? We will be leaving from OLG after 7:30am Mass on Sunday, July 4, 2021, and returning to the church at approxi-mately 6:00pm on Saturday, July 10, 2021. Adults will drive vehicles of participants’ families or rental vans that will serve as transportation to/from West Virginia and back and forth from service sites once we arrive. What can I expect during a week at Bethlehem Farm? When you join us for a week at Bethlehem Farm you can expect to work hard. You can expect to wake up early and go to bed exhausted every night. You can expect to be challenged and supported physically, emotionally, and spiritually. You can expect to have a voice which others will listen to and respect. You can expect to pray in both traditional and creative ways. You can expect to meet nature face to face, to become friends with donkeys and pigs. You can expect to prepare meals from scratch and spend time in the garden. You can expect to feel uncom-fortable at times and at home with complete strangers. You can expect to see God, your friends, and the world in which you live from an entirely new perspective. You can expect a miracle. The group will be living in a cozy farm house facility that can accommodate up to 34 volunteers per service week. On a typical week you will find groups from nationwide schools, churches, and families.

Where is Bethlehem Farm? Bethlehem Farm is in Summers County, West Virginia. It is situated on a mountain between Alderson and Hinton, WV. This south central county of West Virginia was once a prominent coal mining area that now suffers from eco-nomic poverty. How much will the trip cost? The Bethlehem Farm trip’s cost will depend on availability of personal vehicles from attending participants. We will be looking for 3-4 larger passenger vehicles that parents are willing and insured to let chaperones drive to and from West Virginia. Students whose families donate the use of their vehicle will pay a discounted rate for the trip. If 1 personal vehicle is available, cost for the trip will be $500 per student and $400 per student whose family lends a vehicle. If personal vehicles are not available, cost of the trip may increase by as much as $100 per student. This total cost will include transportation, food, lodging, and building materials. We will be requiring $200 to be paid by May 1, 2021. Bethlehem Farm requires early payment for the trip, so this is a necessity. Students may work with the youth minister on personal fundraising efforts, but no group fundraising will take place. There is a Youth Ministry Scholarship Fund that students may wish to apply for some or all of their Bethlehem Farm costs. We encourage students to not let cost be a reason to attend; please talk to us first!

Will anyone get to go on the trip? The Bethlehem Farm trip will be open to students and adults. Students must be at least 16 years old by the first day of our trip. We will have 16 spots this year, and will decide who attends based on seniority, number of previous times attended, and the application essay written with the Volunteer Contract . Please turn in Volunteer Contract (with a sheet attached for the essay if you’d like), Hold Harmless Agreement, and Health Insurance Form (only fill out Adult Health Insurance if over 18) by May 1, 2021. Anyone 18+ should also fill out the Adult Volunteer Background Form. You will then be notified whether or not you will get to attend this year. If you are not chosen for this year’s trip, you will be given preference to go on next year’s Bethlehem Farm Mission Trip.

TRIP INFORMATION

TIMELINE

May 1, 2021 Last day to turn in $200 deposit to Jake Checks made payable to 'Our Lady of Grace' Last day to have 3+ forms turned in to Jake (Volunteer Contract, Hold Harmless Agreement, Health Insurance Form, Adult Background Form for 18+) July 4, 2021 Meet for Mass for students and family at 7:30am at OLG Load cars and Group Prayer Depart for Bethlehem Farm at 9:00am Arrive at Bethlehem Farm between 6:30pm and 7:30pm July 10, 2021 Depart Bethlehem Farm at 10:00am Arrive at Donovan Center at approximately 6:00pm August 1, 2021 Due date for reflections from scholarship recipients

P.O. Box 274

Pence Springs

West Virginia

24962

304.445.7143

bethlehemfarm.net

Week at a Glance The Overview

At Bethlehem Farm, we are more than a “work camp” for volunteers. We invite volunteers to be a part of our mission and our home. We build community with each other by working, praying, laughing, and loving together. We live simply to appreciate the gifts that God has given us. We pray together to grow closer to God and to one another. We serve the local people, we serve each other, and we also open ourselves to be served by others. By living out the Gospel cornerstones of prayer, simplicity, service and community each day of our lives, we offer volunteers not just the opportunity for service, but the opportunity to experience another way of life. Here’s what a typical week* may look like at the farm:

Sunday: Arrival Arrival (between 6:30 pm & 7:30 pm), Tour around the house and possibly the farm (depending on light), Intro to Bethlehem Farm, Cornerstone Prayer Service, Group Leader Meeting, Free time, & Lights out.

Monday: Day at the Farm Wake Up, Morning Prayer, Chores, Breakfast, Dishes, Farm Chores, Lunch, History & Mission of Bethlehem Farm, Farm Hike, Catholic Social Teaching Discussion, Free Time, Dinner, Dishes, Mass, Free Time, & Lights out.

Tuesday – Friday: Days at the Worksites Wake Up, Prayer, Chores, Breakfast, Dishes, Head off to worksites (except home crew), Lunch on site, Return to the Farm, Dinner, Dishes, Evening Prayer, Free Time, & Lights out.

Saturday: Departure Wake Up, Prayer, Breakfast, Dishes, House Clean-Up, Head home (around 10 am) Special programs:

o Tuesday: Community Night – we invite local community members up to the farm for a potluck dinner & occasionally they’ll bring a musical instrument or two

o Wednesday: River of Life Service – we head to a local weekday worship service and join the members for dessert & sometimes a kickball game in the parking lot with the pastor and his son

o Thursday: Shared Prayer – it’s an opportunity for the community to reflect and share where they have seen God in the last week

o Friday: (Summer Months Only) We end the work week with a dip in the Greenbrier River

* This is the schedule for a typical week (Sun-Sat), the schedule adjusts for weeks

that are shorter (Easter Week) or longer.

Recommended Packing List

What to Bring: • Sleeping bag OR sheets and blankets • Work shirts (long-sleeve or short-sleeve shirts, no tank tops or cut-offs) • Sturdy work pants, jeans or khakis (Required for work sites: no shorts or sweatpants) • Work gloves & boots (we have extras if you need some) • Leisure clothes (no revealing clothing, tight shirts or spaghetti strap tank tops) • Leisure shoes (tennis shoes/sandals) • A clean set of clothes for Church services (doesn’t have to be your Sunday best, but something

clean and modest) • Warm sweater or jacket (even in the summer mornings and evenings are chilly) • Rain gear • Modest swimsuit (during the summer months, we may take a dip at the end of the week) • Slippers or indoor shoes (shoes worn outside are taken off at the door) • Toiletries • Modest pajamas (sleeping areas can be quite cool, so pack accordingly) • Sunscreen • Water bottle • Flashlight • Insurance card in case of emergency * Clothes should fit the season of your week here. It can be very cold in fall, winter, and spring and hot in the spring, summer, and fall--please plan accordingly! * The Farm House can be very cool (55-65) from October-May, please take that into account * You can check the weather for the week by looking up Alderson, WV * Do not bring any clothes that cannot get dirty Optional: • Pillow • Snacks to share with all • Your favorite devotions and songs for prayer • Musical instrument(s) • Journal, bible, and/or a book to read • A little spending money (for the Farm store, dinner on the way here, etc.) • Camera • A bag for dirty laundry • Frisbee, football, and things for other free-time activities • Ear plugs (for light sleepers) What NOT to bring: • Bottled water or soda pop (our water is healthier for you and for our Earth) • Watches, iPods, Blackberries, cell phones, or other personal electronic devices (simplicity) • Makeup, hair dryers or curling irons (not necessary—some of the things we give up for the week) • Weapons of any kind • Drugs and/or alcohol

P.O. Box 415

Talcott

West Virginia

24981

304.445.7143

bethlehemfarm.net

VOLUNTEER CONTRACT (Completion of the Volunteer Contract is required for the Bethlehem Farm Trip)

I am fully aware that the volunteer experience at Bethlehem Farm will require me to make personal

sacrifices of which I may not be accustomed. I agree to live this week in simplicity, doing without some of

the conveniences to which I am accustomed. I will work and complete tasks to the best of my ability.

I realize that living and working together in community will require me to display patience and respect

toward all members of the group. I realize the importance of following a schedule and the guidance and

instruction of the leaders. I am willing to comply with the requests of the leadership and be flexible with

what is asked of me.

I am aware that the week will involve a focus on prayer based on the Catholic tradition. I am open to this

experience and will actively participate to the degree that I am able.

I further realize that I will be visiting an area where the culture and the customs may differ from my own.

I will treat all people at the Farm and in the surrounding community with respect.

I agree not to involve myself in drugs, alcohol, or sex while at Bethlehem Farm.

I give consent for Bethlehem Farm to videotape and photograph me during my volunteer week. I

understand these photographs and videotapes may be used for advertising and/or orientation materials for

Bethlehem Farm including the Farm website. I give my permission for possible participation in

videotaping and/or still photographs.

During my group week, I give consent for Bethlehem Farm to post my address, in order to confirm and/or

correct my mailing address and email contact information.

I dedicate myself to be an active participant in this week of service, prayer, simplicity, and community as

an experience of Christian living.

__________________________________________ _______________

Signature Date

__________________________________________ _______________

Parent/Guardian Signature (if under 18) Date

Name (print) ____________________________________________________

E-Mail: ________________________________________________________

Address (permanent) ________________________________________________________

_________________________ Phone _______________________

Address (current) ______________________________________________________________

_________________________ Phone _______________________

Current School or Work _______________________________________________

Class: High School: SO JR SR College: FR SO JR SR Age __________

Home Parish ________________________________________________________

Religious Affiliation ________________________________________________________

Other (information we should know ahead of time): __________________________________________

Have you ever been to Bethlehem Farm (formerly known as the ‘John Filliger Catholic Worker Farm)

before? Y N If so, When?

Please answer this question (use the reverse side if needed): What is your motivation for spending a week

at Bethlehem Farm?

Caretaker: ______ Date: ___/___/___

P.O. Box 415

Talcott

West Virginia

24981

304.445.7143

bethlehemfarm.net

HOLD-HARMLESS AGREEMENT

This agreement entered into on the day _____ of _____________, 20___ is between,

volunteer participant ___________________________ and Bethlehem Farm Inc. This

agreement states that the above mentioned volunteer comes willingly to participate in

Bethlehem Farm Inc. activities and work projects with prior knowledge of the nature of

its work and activities. The above mentioned volunteer/participant will hold harmless

Bethlehem Farm Inc. and any/all employees from any and all injury or liability that may

occur while at Bethlehem Farm or any liability or injury associated with the repair work

initiated by Bethlehem Farm Inc. The above mentioned volunteer also understands that

Bethlehem Farm Inc. does NOT provide medical insurance or coverage to its volunteer

participants during their time here at Bethlehem Farm, and that it is the above mentioned

volunteer's responsibility for coverage should any medical situation arise either during

or after their stay at Bethlehem Farm. It is also understood that Bethlehem Farm Inc.

does maintain adequate liability insurance on its property.

This agreement is entered into by:

Name (please print) _________________________________________________

Permanent Address _________________________________________________

_________________________________________________

_________________________________________________

___________________________________________ _____/_____/_____

Volunteer Signature Date

___________________________________________ _____/_____/_____

Parent/Guardian Signature (if under 18) Date

P.O. Box 415

Talcott

West Virginia

24981

304.445.7143

bethlehemfarm.net

Health Insurance/Medical Release Form Volunteers Under Age 18

Please Print Name of volunteer participant: ________________________________________ Birth Date ___/___/ ___

Circle one: Male / Female Name of parish or school: ______________________

Home Address: _________________________________________________________________________

City: ____________________________ State & Zip:___________________ Phone: (____)____________

Date of this trip to Bethlehem Farm: _______________________________________________

Emergency contact person: _____________________________ Relation to you: _____________________

Day phone: (____)___________________ Evening Phone: (_____)__________________________

Known Allergies: _________________________________________________________

Dietary Restrictions (vegetarian, food allergies, etc.): ___________________________________________

Current Medications: ______________________________________________________

Will you need assistance with your medication(s)? Please specify.

Blood Type (if known): _______________ Date of most recent TETANUS BOOSTER: ___/___/___

Date of most recent physical exam: ___/___/___ ( must be within the last 12 months)

Limitations to physical labor: _______________________________________________

(You will NOT be made to perform any task you are unable to do for whatever reason.)

Emotional/Psychological condition(s) and/or concerns: __________________________________________

Insurance Information: Complete name of Insurance Company: _____________________________________________________

Policy Number/Group Number: ____________________________________________________________

Name on insurance card: _____________________________ Cardholder's date of birth: ____________

Cardholder's social security number: ____________________ Employer's name: ____________________

If an accident occurs mail the claim to: ______________________________________________________

(If you do NOT have health insurance, please contact us at the above number).

**************************************************************************************

For Parents or Guardians:

During the volunteer’s week here at Bethlehem Farm, she or he will ride in vans to and from worksites. Because

parish/school groups are broken up into work groups, it is very likely that your child will ride in a van driven by an adult

chaperone other than your child’s group leader. All vans will only be driven by adults during the week.

I, the undersigned parent or guardian of _________________________(participant’s name) a minor, do hereby authorize

the adult staff members of Bethlehem Farm as my agents, to consent to any examinations, x-ray, anesthetic, medical, or

surgical diagnosis or treatment and hospital care which is deemed advisable by a qualified physician or local hospital.

Bethlehem Farm agrees to contact the undersigned as soon as possible if an emergency should arise. I will assume

responsibility for fees incurred by such an emergency. In addition, I certify that the above information is correct and give

permission for the release of medical records to the attending physician.

_________________________________________________

Signature of Parent or Guardian

_________________________________________________

Printed name of Parent or Guardian

__________________________________________________

Address, City, ST, Zip

P.O. Box 415

Talcott

West Virginia

24981

304.445.7143

bethlehemfarm.net

Health Insurance/Medical Release Form Volunteers 18 and older

Please Print Name of volunteer participant: ________________________________________ Birth Date ___/___/ ___

Circle one: Male Female Name of parish or school: ______________________

Home Address: _________________________________________________________________________

City: ____________________________ State & Zip: ___________________ Phone: (____)____________

Date of this trip to Bethlehem Farm: _______________________________________________

Emergency contact person: _____________________________ Relation to you: _____________________

Day phone: (____)___________________ Evening Phone: (_____)__________________________

Known Allergies: _________________________________________________________

Dietary Restrictions (vegetarian, food allergies, etc.): ___________________________________________

Current Medications: ______________________________________________________

Will you need assistance with your medication(s)? Please specify.

Blood Type (if known): _______________ Date of most recent TETANUS BOOSTER: ___/___/___

Date of most recent physical exam: ___/___/___ ( must be within the last 12 months)

Limitations to physical labor: _______________________________________________

(You will NOT be made to perform any task you are unable to do for whatever reason.)

Emotional/Psychological condition(s) and/or concerns: __________________________________________

Insurance Information: Complete name of Insurance Company: _____________________________________________________

Policy Number/Group Number: _____________________________

Name on insurance card: _____________________________ Cardholder's date of birth: ________________

Cardholder's social security number: ____________________ Employer's name: ____________________

If an accident occurs mail the claim to: ______________________________________________________

(If you do NOT have health insurance, please contact us at the above number).

**************************************************************************************

I, _________________________, do hereby accept financial responsibility for any medical fees that occur either

during or after my stay at Bethlehem Farm. In addition, I certify that the above information is correct.

______________________________________________

Signature of Volunteer

______________________________________________

Printed name of Volunteer:

P.O. Box 415

Talcott

West Virginia

24981

304.445.7143

bethlehemfarm.net

Adult Volunteer Background Form

There is a growing public awareness that many minors have been the victims of physical and sexual abuse from within the family structure, and also from the public at large, including those who care for them, in relation to the parishes, schools, and related activities. The information requested herein is to be furnished by all adult volunteers who are involved with minors at Bethlehem Farm. *It is required that you have a church/school representative sign this form who knows that you are in Safe Environment Compliance in your home diocese.* Please provide us with the following information:

Name: _______________________________________________ Last, First, Middle

Address: _____________________________________________

City: ___________________ State: ______ Zip: ____________

Ph Home: ________________ Ph Business: ________________

Statement of Certification and Authorization

I certify that I have not been accused of or convicted of a felony for committing or attempting to commit crimes in the areas of juvenile prostituting or pimping, obscenity, child pornography, sexual abuse, child exploitation, cannabis control act or controlled substances act. I certify that I have not been convicted of any offense in any other state or against the laws of the United States that if committed or attempted in the state would have been punishable as one or more of the foregoing enumerated offenses. I hereby authorize investigation of all statements contained on this form and certify that all information included herein is complete and accurate. I certify that I have successfully completed sexual abuse awareness training (ie. Virtus) and passed a background check in my home diocese. I have received and read the Policy Relating to Sexual Abuse of Children for the Diocese of Wheeling-Charleston. Diocese: _________________ Date of Training: _____________ *Sexual Abuse Awareness training must be completed prior to coming to Bethlehem Farm. The above information provided is correct & complete.

________________________________ _____________ Signature of Adult Volunteer Date

To be completed by a pastor, Safe Environment officer, director of youth ministry or school principal (You may not sign your own form): The above information provided is correct & complete.

________________________________ _____________ Signature of Diocesan Representative Date

________________________________ ________________________ Printed Name Phone Number