Handbook & Registration Packet

For Superstorm Sandy Relief Workers with

the Monmouth County Long Term Recovery Group


For even the Son of Man did not come to be served,
but to serve, and to give His life a ransom for many. Mark 10:45







355 Joline Avenue, Long Branch, New Jersey 07740
(732) 870-2028 Fax (732) 870-2726
www.lbcovenant.org info@lbcovenant.org

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Table of Contents

Welcome and Arrival . Page 1

Bathroom Page 1

Beach .. Page 1

Bedding .. Page 1

Check In/Check Out .. Page 2

Cleaning .. Page 2

Emergency Phone Numbers . Page 2

Exit Procedures at the End of the Week . Page 2

Fire Drill Page 2

Grocery Store. Page 2

House Rules Page 2

Keys . Page 3

Kitchen Privileges .. Page 3

Laundry .. Page 3

Lodging Donation Page 3

Lounge .. Page 3

Meals . Page 3

Pastoral Care . Page 4


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Table of Contents


Release Forms .... Page 4

Restaurants . Page 4

Security ... Page 4

Showers ... Page 4

Smoking & Alcohol .. Page 4

WiFi . Page 4

Youth ... Page 4

Long Branch Covenant Church History ... Page 5

City of Long Branch History .. Page 6


Attachments:

Cleaning Procedure - Rooms & Bathrooms

Form #1, Mission Group Information

Form #2, Sponsoring Organization Waiver of Liability

Form #3, Individual Participants Waiver of Liability and Indemnity

Form #4, Personal Information

Form #5, Photo Release Form

Photo of Military-style Cots

Cleaning Procedure Showers

Photos of Shower Stall & Shower Truck

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Facility Use and Instructions

Welcome to the church. We are pleased to be able to host you for this week.
We ask that you remember that this is a House of Worship and to be good
stewards of what the Lord has given us. Please leave the facilities as you
found them.

The rest of this manual is in alphabetical order so that you can use it as a
quick reference.

Arrival:
We will collect your waivers, forms, payment and contact
information; and a copy of your health insurance card.
You will be given a tour of the facilities and a set of keys.
There will be a small fellowship reception and dinner will be at the
Lutheran Church of the Reformation.
You will be required to participate in a fire drill.
On Sunday, Wednesday and Friday another church meets here until
10:00pm, and the building may be a bit noisy.

Bathroom:
Bathroom facilities may be found in the atrium, a mens bathroom and
a womens bathroom. There is also a family bathroom in the far Youth
Wing. Leave no toiletries or personal items in the bathrooms.
Bathrooms must be cleaned every Wednesday morning and every
Friday morning. Please bring your own towels.

Beach:
Long Branch has beautiful beaches for you to enjoy in your free time.
We would be glad to give you directions. If you visit the beach,
carefully clean the sand off your shoes, towels, bags and clothes
before you enter the building.

Bedding:
Bring your own sleeping bag, pad, linens and pillow.
Military-style cots will be provided. (See picture in attachments).
If using air mattresses, please bring single size, due to lack of space.
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Blow dryers: Blow dryers may be used in the womens bathroom only.
Using a dryer in the family bathroom or the shower trailer will blow the
circuit. If this happens, please call Joy at (732) 513-7532.
Check-in time/Check-out time: This is flexible, however, we would prefer
advance notice the day before of when you are arriving and when you are
leaving. Church Office (732) 870-2028 or Weekly Host (732) 614-9944.
Cleaning:
Attached to this manual is a cleaning procedure. Please return each
room its original order and cleanliness.
One volunteer must stay behind each day to clean up, which should
take 1 hour. Two volunteers must stay behind twice each week (Wed.
& Fri.) to clean thoroughly which should take 2 hours.
Emergency Phone Numbers: Weekly host (732) 614-9944
Long Branch Police, Fire & First Aid (732) 222-1000 or 911
Rich Glindmeyer, Deacon (732) 403-6698
Terri Tirrell, Deacon (732) 859-2324
Don Clark, Deacon (908) 489-0017
Joy Bastelli, Deacon (732) 513-7532
Exit Procedures at the End of the Week:
Please return the building as you found it and return the keys to
your host. (732) 614-9944
Fire Drill:
Upon arriving you will be required to participate in a fire drill.
Please bring earplugs if needed.
Grocery Store:
Fine Fare, 303 Third Ave., Long Branch.
Shoprite, 145 Monmouth Rd., W. Long Branch.
Aldi, Route 36, W. Long Branch.
House Rules:
No loud music or videos after 10pm.
Violence, profanity, rough housing or sexual abuse will not be
tolerated.
Modest dress is required at all times. Enter and exit shower truck
fully dressed.
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Keys
2 sets of keys will be given to the team leader. Please coordinate
entry and exit to the building amongst yourselves. Important: lock all
inside and outside doors before leaving the building for the day.
Kitchen Privileges:
Commercial Stove and Oven is not available for use at this time.
Refrigerator, microwave and toaster use is available.
Coffee maker and supplies are available.
Laundromat:
There are two washers and dryers in the shower trailer outside the
building.
Hannahs Branchport Laundromat
308 Branchport Ave., Long Branch, NJ
732-229-0700
Lodging Donation:
Suggested donation is $25 per person per night. This may be paid via
check, exact cash or money order. We do not have credit card swipe.
Lounge:
May use DVD player and TV in family room.
Meals:
Continental breakfast food will be available in the kitchen for you to
prepare. A timer on the coffee pot it available to set the night before.
Lunch fixings will be available for you to make and brown bag your
lunch.
Dinner will be served at the Lutheran Church of the Reformation,
992 Broadway, W. Long Branch at 6:30pm each evening. If your
group would rather go out to dinner any evening, please advise
Debbie Keszler, (732) 229-0499 the day before.
Pastoral Care: Deacons are available for prayer and counseling.
Rich Glindmeyer, Deacon (732) 403-6698
Terri Tirrell, Deacon (732) 859-2324
Don Clark, Deacon (908) 489-0017
Joy Bastelli, Deacon (732) 513-7532
For more in-depth pastoral care needs, call the church office at 732-
870-2028 to request an appointment with pastor.
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Release Forms are Attached:
1) Mission Group Information
2) Sponsoring Organization Waiver of Liability
3) Individual Participants Waiver of Liability and Indemnity
4) Personal Information
Restaurants:
Breakfast: Amys Omlette House, 444 Ocean Blvd., Long Branch
North Beach Grill, 49 Atlantic Ave., Long Branch
Rook Coffee Roasters, 700 Joline Ave., Long Branch
Turning Point, 92 Ocean Ave., Long Branch

Lunch: Windmill, 586 Ocean Ave., Long Branch
Ocean Caf, 624 Ocean Ave., Long Branch
Maxs , 25 Matilda Terrace, Long Branch
Salad Shack, 138 Myrtle Ave., Long Branch

Dinner: Johnny Piancones, 591 Broadway, Long Branch
Rockafellers Pizza, 421 Prospect St., Long Branch
Tre Amici, 628 Ocean Ave., Long Branch
Tuzzios Italian, 224 Westwood Ave., Long Branch
Security:
2 sets of keys will be issued and are the responsibility of the group
leader, 1 facility set and 1 shower trailer set.
All doors inside and outside must be locked upon exiting the facility.
Showers: There is a shower trailer outside of the building with 4 individual
shower stalls. Please create a shower schedule with your team. Review
shower trailer use and cleaning procedure at the end of this document.
Smoking & Alcohol: Not permitted in building or on the church grounds.
Storage: There is no storage available at the church for building materials,
donated clothing or household goods of any kind. Please arrange with Amy
Pennenga ahead of time for a drop off site before arriving at the church.
WiFi: Free wifi is available. LBCC Guest, or LBCC Hall; password:
covenant
Youth: Must be age 15 & up. Maximum of 50% youth per group. Youth
must be chaperoned in the building at all times.
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Long Branch Covenant Church Brief History

Long Branch Covenant Church was founded in 1983 with a vision to serve
the people of Monmouth County. The journey began in the living rooms of
members' homes. From there we graduated to a local elementary school
gym, setting up all the furniture and audio-visual equipment and
transforming it into a church.

Setting up and breaking down was our routine for the next 17 years. We
moved from the school to a day camp (with an indoor pool behind the
pulpit) to the basement of another school, then upstairs into the auditorium.
In 2000, an opportunity arose for us to purchase property in Long Branch
where we could begin to build a church!

As a transient church, the Lord taught us perseverance and built our
character (Romans 5:1-6). We learned that the church is the people and not
the building.

It was a joyous day when we finally purchased the land at 355 Joline
Avenue, but our journey was not yet over. While the building was being
built, the Lutheran Church of the Reformation graciously welcomed our
"wagon-train" and gave us the use of their sanctuary on Saturday evenings
for the next 7 years. In 2007, we held our first Sunday morning worship
service in the new building!












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Long Branch New Jersey Brief History:
The town of Long Branch New Jersey, is one of the largest cities on the Jersey
Shore. From the period of the 1860s through the First World War, it was also
the most glamorous.
Long Branchs early years as a resort town was a virtual Whos Who of
society, including such names as Astor, Fisk, & Drexel and even more
notorious names such as Diamond Jim Brady and Lily Langtree. First Lady
Mary Lincoln visited in 1861, but it was in 1869 that Long Branch NJ had its
first presidential visit by President Grant. The President continued to visit
every summer that he was president, and continued for many years after that.
In 1870, a racetrack opened, and soon after, casinos. Long Branch NJ was in
its heyday, such was its reputation that seven other presidents followed suit in
visiting here. Chester A. Arthur, Rutherford Hayes, Benjamin Harrison,
William McKinley, Woodrow Wilson and James Garfield were frequent
summer visitors. After an attempt was made on James Garfields life, he was
brought to Long Branch NJ in hopes of a recovery aided by the sea air. Indeed,
a railroad spur from the main line to his house was built to make him more
comfortable in his travels.
The 1920s witnessed the beginning of Long Branchs decline as a fashionable
summer destination. Gambling laws stopped many of the rich and famous from
visiting, and wicked storms eroded Long Branchs famed beachfront. By the
latter part of the 1960s, crime rose in Long Branch further tarnishing its image.
Buildings became run down, houses became shabby, and many locals had to
depend on welfare. Sadly, the only remaining structure of Long Branchs
former elegance is the St. James Episcopal Church. Built in 1879, it is where all
seven presidents worshipped. It has since been renamed Church of the
Presidents and is located at 1260 Ocean Avenue.
Fortunately, since the beginning of the 21
st
century, Long Branch is
experiencing a rebirth. Visitors to Long Branch now can enjoy Pier Village, the
beach, as well as Seven Presidents Oceanfront Park, a 33-acre county park with
facilities for swimming, boating and picnicking. Some of the summer bungalows
have been replaced with high-rise condos. There is also a large selection of
outstanding restaurants as well as a lively nightlife for the young or the young
at heart!
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Cleaning Procedure after Building Use

Cleaning instructions for each area are posted on the wall in the maintenance closet. Cleaning product
instructions are also posted on the wall. Please review. If you have any questions, please call Lorraine
Dente at (908) 489-9113.
Kitchen
! Counter: Clean with Green Works all purpose cleaner and regular sponges
! Dishes: Use the sponge with the scrubber side
! Floors: Sweep. Clean up spills using paper towels (no sponges on floors)
! Rags: Top wire shelf. Toss dirty ones in hamper
! Food: Seal all food. Refill drinks in refrigerator
! Wash coffee pot
! Refrigerator: Clean up all spills
! Unplug toaster and coffee pot
! Empty trash and replace liner
Foyer/Tables and Chairs
! Wipe down each table and chair after use
! Sweep marble floors, vacuum, if necessary
! If necessary (for spills and sticky soiled areas), wash with Super Shine- All, only
Restrooms
! Inspect each stall for urine and litter
! Sanitize each used toilet with Clorox Clean-up and Soft Scrub
! Collect litter
! Replace any empty toilet paper rolls (2 extra rolls should be on back of each toilet)
! Wipe down countertops, sinks, soiled wall areas and door handles using
H2Orange2
Concentrate 117 in hot water with sponge.
! Windex mirrors
! Refill paper towel dispensers if low (Refills are under sink in nursery area)
! Check walls for any soiled areas
! Empty trash and replace liner
! Sweep and wash floor if soiled with H2Orange2 Concentrate 117 in hot water
! Clean prints off metal plates on doors with stainless steel cleaner
Shower Trailer
After every shower:
! Spray with Tilex Daily Shower Cleaner
! Remove hair from drain.
At the end of each day:
! Spray shower stall with
Scrubbing Bubbles.
! Spray shower stall floor with
Clorox Clean-Up.
! Rinse with hot water using the plastic
container.
! Remove hair from drain.

Sleeping Areas/Rooms
! Vacuum carpets
! Empty trash and replace liner

Glass
! Inspect glass doors for fingerprints and
smudges
! Clean dirty areas with Easy Glide liquid
cleaner as follows:
Add 1/4 capful of Easy Glide glass cleaner to
small bucket of warm water. Slightly dampen a
clean, soft, lint-free cloth or paper rag from
the Box of Rags and spot clean the soiled
areas.

Trash
! Collect all trash in areas used and replace
with a clean liner bag
! Bring collected trash to dumpster through
the small-unlocked door on the side of the fence


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Form #1
MISSION GROUP INFORMATION for
Long Term Disaster Recovery Work in the Monmouth County, NJ Shore Area With Lodging
at Long Branch Covenant Church
355 Joline Ave., Long Branch, NJ 07740

This mission trip is for the period from ______________through______________
Sponsoring Organization data:
Name____________________________________________________________________

Address___________________________________________________________________

Phone__________________________________Fax_______________________________

E-mail of sponsoring organization ___________________________________________

Group Leader:
Name____________________________________________________________________

Address___________________________________________________________________

Phone__________________________________Fax_______________________________

Email____________________________________________________________________

Number of males in mission group_____Number of males under age 18______

Number of females in mission group_____Number of females under age 18______

Total Number of mission group members____________________

Note: All group members must be 15 years of age or older. There must be an adult supervisor
for each teen under the age of 18.

Initial Contact:
Please make your reservations through the Lutheran Social Ministries of New Jersey. Call
Amy Pennenga, (609) 699-4137.

It is important to understand Mission Groups are not employees, agents or representatives of
Long Branch Covenant Church and the church is not responsible for the activities or conduct of
the Mission Groups or their members. In this endeavor the Church is functioning only in the
capacity of a host for the residency needs of the group and is not a sponsor, supervisor or
director of any of the Groups activities with any particular project or work site.




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Form #2
SPONSORING ORGANIZATION WAIVER OF LIABILITY

Long Term Disaster Recovery Work in the Monmouth County, New Jersey Shore Area
With Lodging at the Long Branch Covenant Church,
355 Joline Avenue, Long Branch, NJ 07740

I, the undersigned represent to the Long Branch Covenant Church that I am a duly authorized
representative of the____________________________________________________________
(Sponsoring Organization)
and execute this waiver of liability on behalf of the sponsoring organization.

I acknowledge on behalf of the Sponsoring Organization that the mission group participants of
said organization that will be staying at and participating in a project coordinated by the
Lutheran Social Ministries of New Jersey or third parties will be doing so at the mission group
participants own risk. I, on my own behalf and that of the Sponsoring Organization, hereby
remise, release, indemnify, hold harmless and forever discharge Long Branch Covenant
Church, its ministers, elders, deacons, members, volunteer officers, trustees, agents and
employees of and from all manner or action and actions, suits, judgments and sums of money,
dues, claims, liabilities or demands, whatsoever, which arise out of or in any manner grow out
of, damage, injury or illness or death, including injuries or damages known or unknown to any
mission group participant or his/her property during his/her participation in or travel to or from
any mission project or related event or presence upon the Host Sites property by reason of
being permitted to stay at Long Branch Covenant Church.

I agree on behalf of the sponsoring Organization to be responsible for any and all expenses
incurred by participants for damage or accident to the Long Branch Covenant Church
property.

ATTACHMENTS: The following forms have been duly and properly filled out, executed and
attached:
An Individual Participant Waiver of Liability (Form #3) for each participant has been
signed by them and by both parents or the legal guardians if they are under 18 years of
age.
Mission Group Information (Form #1) for the Sponsoring Organization.
Attached is a certificate of insurance of the Groups Sponsor Organization naming the
Long Branch Covenant Church, its officers, agents and employees as additional insured.
The Sponsoring Organization is covered by its own insurance policy or policies issued
by:
Company__________________________________________________________
Policy No._______________________________________________________________

Name/phone number/address of local agent





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Form #2, contd

This Mission Trip is for the period from
_____________________to______________________ in Monmouth County, New
Jersey Shore Area.

By: ___________________________________________________________________
(Authorized Representative of the Sponsoring Organization)

Title: ___________________________________________________________________

I the undersigned authority, a Notary Public in and for
_________________________________________________

Hereby certify that __________________________________whose name as

___________________________________________________________________

(title) of __________________________________________________a Sponsoring
Organization, is signed to the forgoing waiver of liability, and who is known to me,
acknowledged before me on this day that, being informed of the contents of this
instrument, he/she as such____________________________(title) and with full
authority, executed the same voluntarily as and for the act of said Sponsoring
Organization.

Sworn to before me this ____ day of _______________, 20____.

State of ______________________________________________________

County/City of _________________________________________________

Notary Public _________________________________________________

My term expires _______________________________________________

Notary Seal












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Form #3

INDIVIDUAL PARTICIPANTS WAIVER OF LIABILITY AND INDEMNITY

Long Term Disaster Recovery Work in the Monmouth County, New Jersey Shore Area
With Lodging at the Long Branch Covenant Church
355 Joline Ave., Long Branch, NJ 07740

I, ___________________________________________, (the undersigned) as a member of the

_________________________________________________ Organization will be participating in a
Mission Group involved in various projects for the restoration and recovery of the Monmouth County
New Jersey shore area. Said projects are to restore properties damaged in Superstorm Sandy October
2012. As a participant and in consideration of being permitted to reside at Long Branch Covenant
Church, I understand and agree to the following:

That I will be staying at the Church and participating in these projects of my own free will as a volunteer
and at my own risk and responsibility. I understand and agree that the Church, its minister, elders,
session, members volunteers and/or employees are not responsible or liable in the event of an accident,
injury or illness including death occurring to me. In that regard I remise, release, indemnify and forever
discharge and hold harmless for myself, my heirs and assigns the Church, its minister, elders, session,
members, volunteers and/or employees from any liability, claim, suit, cause of action or judgment
whatsoever arising out of or involved with my participation in the Mission Group and presence on the
property of Long Branch Covenant Church.

I hereby state that I am in good health and have all the medications necessary to treat any allergic or
chronic conditions. I am able to administer such medications without assistance. If at any time during my
participation I require medical care and am not able to give consent due to my physical or mental
condition, I authorize treatment by a licensed physician or other medical professional in regard to my
care. I specifically release the Church and the leaders of the Mission Group in making those emergency
medical care decisions, from any and all liability associated with said decisions, even if injury or death is
the result of the decision.

I understand that as a Mission Group participant, I will be performing certain tasks that could result in
serious injury and/or death, including, but not limited to debris removal, sorting and packing relief
supplies, and/or assisting in the repair and/or construction of personal residences, structures and other
project activities. I further understand and voluntarily assume all risks associated with any tasks I may
perform as a Mission Group participant.

The undersigned shall be responsible for any and all damages to Church property while said premises are
being used for the specified activities. The Church reserves any and all remedies at law to collect any
damages which may result from the use of said premises by the undersigned.




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Form #3, contd

I agree to participate to the best of my ability in the projects that are planned as well as in the Mission
Groups activities and responsibilities. I understand that the use of alcohol and smoking on Church
property is prohibited. The use of drugs not prescribed for me by a licensed physician, at any time during
the mission trip are prohibited and will not be purchased, possessed, or consumed by me during the
mission trip. Finally, I also understand violations of local laws or ordinances will not be tolerated. If I fail
to comply with these policies, I understand that I may be told to leave or sent home immediately at either
my sponsoring groups or my familys expense.

The undersigned expressly warrants that this Release and Indemnity Agreement is to be binding upon
his/her executors, successors, administrators and assigns. It is further warranted by the undersigned that
no promise or inducement has been offered, except as herein set forth and that the undersigned or the
undersigned parent or guardian is of legal age, legally competent to execute this agreement and agrees to
all the terms of this Release and Indemnity Agreement, making all warranties herein set forth and
accepting full responsibility therefore. This release is a full and final release of all claims known and
unknown, anticipated and unanticipated.

The undersigned has read this Release and Indemnity Agreement and fully understands it. The
undersigned agrees that his/her agreement shall be governed by and interpreted in accordance with the
laws of the state of New Jersey. The undersigned further agrees that in the event any clause or provision
of this agreement shall be held to be invalid by any court of competent jurisdiction, such invalidity shall
not otherwise affect the remaining provisions of the agreement, which shall continue to be enforceable.

I/We the undersigned individual(s) and/or parents/guardians of the above named mission group
participant will be staying at the Church and participating in a project or projects at his/her and my/our
risk. I/we on my/our own behalf, hereby remise, release, indemnify and forever discharge and hold
harmless for myself, my heirs and assigns the Church, its minister, elders, session, members, volunteers
and employees from all liabilities for damage, injury, or illness including death to the mission participant
or his/her property during his/her participation in or travel to or from any mission project or related
event. We also understand and agree to all representations, comments and warranties made herein.

Further, I/we authorize the leader(s) of the mission team on my/our behalf and at my/our account to take
such measures and arrange for such medical treatment by a licensed physician and hospital treatment as
the leader(s) of the mission team may deem advisable for the health and well-being of the participant
without need for further consent or permission.

In witness whereof the undersigned has/have executed this Release and Indemnity Agreement on the date
or dates indicated.
Participant Signature ___________________________________ Date_______________________

Signature of Parent or Legal Guardian ___________________________ Date _________________

Signature of Parent or Legal Guardian ___________________________ Date _________________


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Form #3, contd

Notary is required for minors only.

I the undersigned authority, a Notary Public, Hereby certify

that: ________________________________________________________________________

____________________________________________________________________________

Whose name(s) as the parent(s) and/or Legal Guardian(s) as the case may be, is or are signed to the
forgoing INDIVIDUAL PARTICIPANTS WAIVER OF LIABILITY AND INDEMNITY and who
is known to me, acknowledged before me on this day that, being informed of the contents of the
instrument, he/she, as such:
_____________________________________________________________________________
(individual, parent or Legal Guardian)

and with full authority, executed the same voluntarily as and for the act of said person. Sworn to before

me this ______ day of ________________________, 20____

State of ______________________________________________________________________

County/City of _________________________________________________________________

Notary Public __________________________________________________________________

My term expires ________________________________________________________________

Notary Seal


















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FORM #4

PERSONAL INFORMATION
Long Term Disaster Recovery Work in the Monmouth County New Jersey Shore Area
With Lodging at the Long Branch Covenant Church
355 Joline Avenue, Long Branch, NJ 07740

Name_________________________________ Age_____ Date of Birth_________

Address___________________________________________________________

__________________________________________________________________

Phone________________________ E-mail_______________________________

Cell__________________________

Emergency Contact Information:

Name_____________________________Relationship______________________

Daytime Phone______________________ Evening Phone___________________

Primary Medical Insurance Carrier_______________________________________

Policy # ___________________________________________________________

Secondary Medical Insurance Carrier ____________________________________

Policy # ___________________________________________________________

Are you allergic to any foods or medications? ______ If yes, please list

__________________________________________________________________

Do you have any medical conditions or physical limitations the leaders should know

about? If yes please list:
__________________________________________________________________

Participant Signature ________________________________ Date ____________

Please attach a copy of your health insurance cards.



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FORM #5




3 Manhattan Dr|ve, 8ur||ngton NI 08016 | (609) 386-7171 | I (609) 386-7191 | www.|smn[.org


Consent for Use of Image and Voice Recordings in
Promotional and Informational Materials

Date: ________________ Event: ___________________________

I, the undersigned, authorize photographs, vocal recordings, and similar image and vocal representations to be made of
me/my child/person for whom I am guardian by an authorized representative of Lutheran Social Ministries of New Jersey
(LSM/NJ). I understand these may be used as photographs, videos, or other mediums in displays, professional journals, or
other LSM/NJ publications, illustrations, and electronic media for both internal and external use. I waive all rights that I
may have to claims for payment of royalties or other compensation in connection with use of these images and/or
recordings.

I agree to let LSM/NJ post images of the individual listed below on Facebook, LinkedIn, and other electronic mediums for
the purpose of promoting or informing the public about LSM/NJ. This gives permission to LSM/NJ to tag photos of the
individual listed below that will be able to be viewed on my Facebook page as well. I understand that images posted on
social media websites may be accessible to others who are not necessarily affiliated with myself or LSM/NJ. I also agree to
let LSM/NJ post approved text about the individual listed below -- for use on the LSM/NJ website and other electronic
forms of communication affiliated with LSM/NJ.

Person being photographed, video taped or recorded: (please print)
NAME: ___________________________________________________________________________
ADDRESS:_________________________________________________________________________
________________________________________________________________________________
E-MAIL (optional): __________________________________________________________________

Consent for minors and persons with guardians must be signed by parent/guardian. (If applicable)
NAME of Parent/Guardian: ___________________________________________________________
ADDRESS:_________________________________________________________________________
________________________________________________________________________________
E-MAIL (optional):__________________________________________________________________
TITLE/RELATIONSHIP to person listed above:___________________________________________

Signature _____________________________________________________________________


LSM/NJ Representative: _____________________________________________________


Established in 1904, Lutheran Social Ministries of New Jersey (LSM/NJ) is a mission-driven, grace-filled not-profit organization committed to using its combined
expertise to serve those in New Jersey who hurt, who are in need, or who have limited choices. With more than 20 sites across the state, LSM/NJ is a provider of
quality senior care services as well as community programs such as adoption, immigration & refugee services, community residences for the developmentally disabled,
a homeless day shelter, and affordable housing for seniors and families. For more information, call 609-386-7171 or visit www.lsmnj.org.


07.16.2013


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These military-style cots are available for sleeping. Remember to bring
a sheet, sleeping bag, pillow and pad, if necessary.








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Shower Trailer Use and Cleaning Procedures

1. Make sure the fan or a/c is on turned in the front
compartment. This supplies air to each shower.

2. Only the lights may be turned on as well, when the
air conditioning is turned on or the circuit will blow.

3. Turn a/c off before using the washers and/or dryers.

After every shower:

1. Please spray Tilex Daily Shower Cleaner

2. Remove hair from drain.

At the end of each day or the last shower of the day:

1. Spray shower stall with Scrubbing Bubbles.

2. Spray shower stall floor with Clorox Clean-Up.

3. Rinse with hot water using the plastic container.

4. Remove hair from drain.

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