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I. Humanitarian Online Form
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Jammu and Kashmir
Andaman and Nicobar Islands
Dadra and Nagar Haveli
Daman and Diu
National Capital Territory of Delhi
Pro-forma to be filled in by Prospective Medical Camp Organizers
2. Address (including telephone and email address if any):
3. Full time ministry-Yes/No. Part time ministry- Yes/No. If none of these, kindly explain what your ministry is.
4. If doing part time - whether after retirement or doing job?
5. Name of church and number of members:
6. Which diocese / denomination, if relevant:
7. Working among which community / socio-economic status:
8. What are the 5 predominant diseases you have noticed in your area?
9. How do you think conducting a medical camp will help in your ministry? Please be specific.
10. What do you plan to do after the medical camp?
11. Brief personal testimony:
12. How many patients do you expect to come for the camp?
13. Name the villages you cover in your ministry and those covered by your assistants and how regularly?
14. How many pastors, volunteers & councilors ministering in the same area will you be able to assemble for this camp? Will they be able to come a day before the camp for planning?
15. How many doctors, nurses or technicians will you be able to contact and call for the camp?
16. Can you think of a place where the camp can be held other than the church building for e.g. school building / Panchayat Office (some building / structure with a rain proof roof and able to accommodate the waiting patients of up to 50), is this building likely to have electricity?
17. Can an electrician, generator and a shamiana be arranged for in the village of the camp or do we have to get them from another village? How far is this other village?
18. For camps outside Hyderabad, can you contact a hospital nearby for surgery? Name the surgeon, the hospital address and telephone nos.
19. How did you come to know about the Medical Camps, Operation Blessing India / CBN?
2. Email Address:
3. Address (including telephone if any):
4. Bore well required at:
5. Village Name:
6. Mandal & District.:
7. Name of the Local Contact Person :
8. Address/Phone No.:
9. Total Population of the Village:
10. No. of Beneficiaries:
11. Present Water Source:
12. Distance of Present Water source:
13. Occupation of the People:
14. Pastor/Ministry Details:
(Enclose Pastor Testimony)
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