Please give details if possible:  ___________________________________________________

____________________________________________________________________________

What materials and Labor could you provide:  _______________________________________

Please state reason assistance is needed: ____________________________________________

Do you own the house for which you are asking repairs?  ______

Is this your primary residence?  ______                  Is this a rental property?  _____

If you rent the house from who do you rent?  ________________________________________

                                          Landlord’s phone: ________________________________________

All of the stated information is accurate to my knowledge.

Applicant’s signature:  _____________________________________

I agree to and understand the following when applying for and receiving assistance from the “Together for Lincoln” program:

I understand that simply applying for assistance does not guarantee that “Together for Lincoln” will be able to fill my request.

1.      I understand that everything asked for on the application may not be done to my house and that often only some of the asked for assistance is received.

2.    I agree to have someone present at my home during the time work is being done.

3.    I understand that sometimes a volunteer group may start a project and due to uncontrollable circumstances may not be able to finish the project.  I also understand that “Together for Lincoln” will try to finish the work, but they do not promise or guarantee that a project will be finished on time. 

  They will make every effort to complete the project as soon as possible.

4.   I understand that pictures may be taken of projects at my home, and may be used to promote in a

      positive manner the ministries of church groups/“Together for Lincoln.”

5.   I understand that pictures may be taken of projects at my home, and may be used to promote in a 

      positive manner the ministries of church groups/“Together for Lincoln.”

6.      This Hold Harmless, Covenant Not to Sue and Indemnification Agreement is entered into on  

      ___________, between “Together for Lincoln”, the "Volunteers," and the Owner(s) of the property: 

      ______________________________________________________________________________       

     Now, therefore, in consideration of the Volunteers performing such work at no charge, the parties do

     agree:  Owner, for himself, and for his heirs, assigns, guests and invitees, covenants not to sue the

     Volunteers for any reason, including, without limitation, negligence and failure to perform in a

     workman-like manner, in connection with the performance by the Volunteers under this agreement.

       Owner, for himself, and for his heirs, assigns, guests and invitees shall hold the Volunteers harmless

       and indemnify them from any and all liability for any reason, including, without limitation, negligence

       and failure to perform in a workman-like manner, in connection with the performance by the Volunteers  

       under this agreement.

Applicant’s Signature:  ____________________________________    Date:________________

                                                                          2