Application for Home Repair and Construction Project
To be filled out by Property Owner or SERVE Team Member for project consideration.
If completed by/with the Property Owner, please attach the Homeowner Waiver and Release of Liability with this application. Contact us at SERVEnoblesville@gmail.com for any questions.

Please read and review our Project Introduction Letter that explains the scope and expectations of the application process. Click here: http://servenoblesville.org/sites/servenoblesville.com/files/17_Homeowner_Intro_Letter.pdf

Name of Property Owner: *
Your answer
Address of Project Site: *
Your answer
Property Owner Home Phone #:
Your answer
Property Owner Work/Cell Phone #: *
Your answer
Is the Property Owner: *
Required
Total monthly income of all persons residing in address above: *
Your answer
Is this the only property owned by this Property Owner? *
Is the Property Owner employed? *
Required
Is the Property Owner a member or regular attendee of a local place of worship? *
Is the Property Owner a member of a community organization? *
Please Describe why the Property Owner needs SERVE Noblesville to help with property repairs.
Your answer
Describe the work that needs to be done at the property. Please be as specific as possible. *
Your answer
Friends and family members of the Property Owner are encouraged to help with the repairs. List the names, addresses and phone numbers of family and friends who would be willing to participate. *
Your answer
List any other entities and contact information who have an interest in the property. *
Your answer
Is the Property Owner aware of this referral? *
This is a one-week program. The work is done by volunteers at no cost to the property owner. Able-bodied adults relatives living with the Property Owner are requested to work on the property on the SERVE Noblesville work week. We do not guarantee that all the work will be completed, but we will make the best effort to have the work done. SERVE Noblesville 2017 runs from June 28-July, 2017. The Property Owner is expected to be available during those dates or to make appropriate arrangements with the SERVE Team Leader. If you agree and accept the terms of these conditions, type your name here. *
Your answer
How did you hear about SERVE Noblesville?
Your answer
Name of person submitting this referral if different than Property Owner
Your answer
Business or Organization Your Representing (if any)
Your answer
Preferred Contact Phone:
Your answer
Date:
MM
/
DD
/
YYYY
Waiver and Release of Liability
Where the term "ome Owner" is stated herein, it is also construed to mean "Property Owner" and all other parties having an interest in the property, as is appropriate for the property.
In exchange for the repairs done to my home by volunteers from SERVE Noblesville, agree to be bound by each of the following: *
Your answer
1. Voluntary Agreement. I am voluntarily signing this Waiver and Release of Liability ("Waiver") and if any portion is unclear, or if I do not understand the terms, I requested an explanation. I realize that I may consult with an attorney before signing this Waiver.
2. Identification of Risks. I understand that serious accidents may occur during construction and that I may incur physical harm, including the possibility of permanent disability. This Waiver addresses all of the risks associated with any aspect, including risks created by the actions, inactions, carelessness, or negligence of SERVE Noblesville.
3. Assumption of Risk. I assume all risks, known and unknown, foreseeable and unforeseeable, connected with all work performed by SERVE Noblesville.
4. Release and Waiver. I release SERVE Noblesville from any liability and waive all claims for injury, loss, damage, or expense (including attorneys' fees) associated with my use of the repairs, whether caused in whole or part by the negligence or misconduct of SERVE Noblesville or any other participant involved in the construction.
5. Binding Effect. This Waiver is binding upon my relatives, personal representatives, heirs, beneficiaries, next of kin, or assigns and is written to benefit SERVE Noblesville.
6. Severability. If any provision (or a portion of any provision) of this Waiver is found to be invalid or unenforceable, that provision will be enforced to the fullest extent permitted by law. Any invalidity or unenforceability does not affect the rest of this Waiver.
7. Applicable Law. This Waiver shall be controlled, interpreted, and enforced in accordance with Indiana law.
THIS IS A WAIVER AND RELEASE OF LIABILITY. I HAVE READ THIS DOCUMENT. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I AM SIGNING THIS WAIVER AND RELEASE OF LIABILITY VOLUNTARILY. I ACKNOWLEDGE THAT I HAVE THE POWER AND AUTHORITY FROM THE LAND OWNER/PARTY WITH INTEREST TO ENTER INTO THIS AGREEMENT WITH SERVE Noblesville

Type Name (by electronically signing you are agreeing to all of the above) *
Your answer
Please complete by April 1st, 2017.
SERVE Noblesville partners with White River Christian Church as our fiscal and insurance partner. Faith Community Church serves as our administrative partner. All questions and inquiries can be sent to servenobelsville@gmail.com. Financial donations and contributions can be sent to:
SERVE Noblesville
c/o White River Christian Church
1685 North 10th Street
Noblesville, IN 46060
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