Volunteer Liability Waiver & Media Release

Homeowner Name:*

First NameLast Name

Homeowner Date of Birth:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

Please check any that apply:

Senior (Age 65+)VeteranPhysical DisabilityOther

Race/Ethnicity*:

Combined Household Income (Monthly Estimate)*:

Please list anyone else who lives in the home, their relationship to you, and their ages:

Have you received a citation from University City?

YesNo

If yes, please upload a copy.

Can you contribute to the cost of materials for this work?

YesNo

If yes, what amount?

Briefly describe one or two items you are requesting. SHED volunteers only do minor EXTERIOR repairs. SHED generally assigns 3-4 volunteers for a half-day of work and will prioritize issues to help keep you safe, warm, and dry, or that have resulted in a citation. *

Program Rules (Please read carefully)

If possible, the resident or their family should contribute to the project financially or by assisting with the work. This will allow us to help as many residents as possible.
Volunteers will not work above the roofline of a one-story house. They will not prune tree limbs requiring power tools.
Team leaders/volunteers have the right to refuse any project they deem unsafe or are not comfortable doing.
Work is not guaranteed to be completed. The volunteers will leave the property in a safe and orderly condition.
All volunteers, staff, and residents will treat each other with respect. Any problems should be directed to SHED staff/board.
Having past work completed by SHED does not guarantee future projects will be accepted.

Liability and Media Release Waiver

I do hereby fully release and discharge SHED, Inc., any officers, agents, servants, and employees, and all sponsors, partners, participating agencies, companies, and all other program participants and volunteers from any and all claims from property damages, injuries (including death), damage or loss which I may have or which may be accrued to me on account of my participation in the program.

I further agree to indemnify and hold harmless and defend SHED, Inc., and officers, agents, servants and employees, and all sponsors, partners, participating agencies, companies, and all other program participants and volunteers from any and all claims resulting from injuries, including death, damage and losses sustained by me and arising out of, connected with, or in any way associated with the activities of this program.

I also grant SHED permission to photograph and use images from any volunteer work performed on my property.

I HAVE READ AND FULLY UNDERSTAND THE ABOVE PROGRAM DETAILS AND WAIVER AND RELEASE OF ALL CLAIMS.

Homeowner Signature:*

Homeowner Name:*

Date

*Data used in the aggregate for grant application purposes. Will not be shared outside of SHED.

Volunteer Home Maintenance