Request for Home Assessment Form
Purpose
This form is to be used by Las Sendas homeowners to request a fire risk home assessment from a volunteer community member who has been trained in providing such assessments. After the assessment, you will be provided recommendations for wildfire risk reduction actions that can be taken on your personal property to improve your home survivability due to a wildland fire threat.
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Acknowledgement
I understand that this risk assessment will be conducted by a volunteer community member who has completed the Home Ignition Zone Course from the National Fire Prevention Association, but that the person completing the assessment is not a professional. I further understand that the recommendations are intended to reduce the risk of damage to my home, but that following the recommendations is not a guarantee that my home will be protected from a wildfire. I understand that, as the homeowner of my property, I am solely responsible for protecting and insuring my home. I agree to waive, release, hold harmless and discharge from any and all liability the Las Sendas Community Association, CCMC, and their directors, officers, employees, volunteers, representatives and agents for any property damage, property loss, death, disability, or personal injury which may result from a wildfire or other act of God as a result of this assessment or the recommendations that follow.
Signature
Submit
Should be Empty: