ROC Builders: Assistance Application

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Are you a member of River Oak Church?*

YesNo

How long have you been a member of River Oak Church?*

Have you received help from River Oak Church in the past?*

YesNo

If yes, please explain: *

Please provide a brief description of the repairs needed to your home: *

Explain briefly why you are unable to complete the repairs on your own: *

Are you financially able to pay for materials needed to complete the repairs?*

YesNo

Please provide us with any additional information you think will be helpful in evaluating this request: *

Applicant Agreement (Please read carefully)

I certify that I have homeowner’s insurance. I confirm that, except for conditions which may be described in this application, my home and the surrounding area are safe places for volunteers. If requested, I agree to provide financial records to verify ownership of this property and insurance. I also understand that, because this is a volunteer organization dependent on donated services, materials and funds, ROC Builders, a ministry of River Oak Church, reserves the right to revoke acceptance of any home into its ROC Builders ministry for any reason at any time. If this waiver and release of claims is found ineffective by a court of law, then I waive all claims against ROC Builders, a ministry of River Oak Church, and everyone associated with it, for property damage or personal injury to the extent that those claims are covered by any health or property insurance that I may have. I understand that the people who may work on my home are unpaid volunteers; that few (if any) of these volunteers are skilled in the building trades; and that ROC Builders, a ministry of River Oak Church, MAKES NO WARRANTIES OR REPRESENTATIONS, EXPRESS OR IMPLIED, ABOUT ANY OF THE MATERIAL(S) USED OR WORK DONE BY ANYONE ON MY HOUSE. I hereby release ROC Builders, a ministry of River Oak Church, and all associated with it, from all liability arising from negligence for any personal injury or property damage arising out of or relating to the work done on my house. I also grant ROC Builders unrestricted permission to use, copy, reproduce, alter, display, distribute, publish, and/or exhibit any pictures, video or narrative in which I may be included through any means of communication whatsoever for any lawful purpose whatsoever. I further release and discharge ROC Builders, a ministry of ROC Church, from any and all claims arising out of such use or activity. In no event will ROC Builders, a ministry of River Oak Church be liable for any incidental or consequential damages. Please note that, to assess your home’s suitability for our program, we reserve the right to inspect the home and the property surrounding it. Your signature below gives us permission to inspect your home and surrounding property. BY SIGNING THIS DOCUMENT, I HEREBY CONFIRM THAT ALL INFORMATION IN THIS APPLICATION IS CORRECT AND THAT I UNDERSTAND AND AGREE TO THE STATED TERMS AND CONDITIONS.

Signature of Applicant: *

Today's Date*

Date

A ROC Builders team member may be in touch with you to schedule an inspection of your home and get more details of work requirements. You will be notified if you are selected to receive help from ROC Builders.

ROC Builders: Assistance Application

Applicant’s Information: