PLEASE LIST NAMES AND AGE OF ALL OCCUPANTS OF THE PROPERTY (YOURSELF INCLUDED):

Please consider each question carefully and answer honestly. These questions will help us determine if you are eligible for the program.

IF YES, PLEASE LIST EMERGENCY CONTACT INFORMATION:

The undersigned homeowner hereby requests and gives consent to Hands On Housing, a program of Interfaith Action of Central Texas, a charitable corporation, to work on the property described below, and understands and agrees to the following terms and conditions relating to work performed or materials furnished to the property and release of personal information:

1. Hands on Housing has not made any representation, warranty or promise relating to the materials or workmanship. Hands on Housing is primarily volunteer driven. We do not guarantee work to be done without imperfections as our workers are not always professionals of the given field.

2. Hands on Housing expressly disclaims any expressed or implied warranty for our volunteer services,including any warranty or fitness for a particular purpose, relating to the materials or workmanship.

3. Hands on Housing shall not refund, repair, replace or take any remedial action with respect to the materials or workmanship.

4. The undersigned hereby releases and agrees to indemnify, defend and hold harmless Hands on Housing and Interfaith Action of Central Texas, its employees, and volunteers from any and all claims or causes of action arising out of or relating to work performed or materials furnished to the property.

5. The undersigned hereby authorizes Hands on Housing and Interfaith Action of Central Texas to release any personal information for the purpose of soliciting volunteer support. The client’s personal information may be gathered from the following two sources:

• His or her Hands on Housing application for assistance

• From any home visit with the client by iACT employee or volunteer authorized by the Hands on Housing office. This includes the use of photos.

6. The undersigned Client further authorizes iACT to use the Client’s image(s) or likeness of his/her image(s) to be utilized in photography, website, videography, and promotional materials related to this and other community events.

7. The undersigned Client authorizes Hands on Housing/iACT to release information on the homeowner application to partner service organizations (Austin Area Urban League, Habitat for Humanity) and other organizations that may be of help to you.