Restoration Grease and Grace Program

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Services Needed*

BreaksOil ChangeHeadlight ReplacementDiagnostics

Appointment

Please list if you have another request for mechanical work?

Make, Model, and Year of Car?*

IF you are unable to make it or have any questions please call Dalton Cooper at (606) 250-8217

RESTORATION MINISTRIES – GREASE AND GRACE PROGRAM WAIVER AND RELEASE OF LIABILITY

I, the undersigned, acknowledge and understand that Restoration Ministries (“the Non-Profit Organization”) through its “Grease and Grace” program, provides free automotive services, including but not limited to oil changes, diagnostics, brake services, headlight replacement, tire plugs, and similar services, as an act of goodwill to widows and single mothers.

I further acknowledge and agree to the following:

1.Voluntary Participation
I am voluntarily allowing my vehicle to be serviced by the Non-Profit Organization and its volunteers. I understand that the services are provided at no cost and without any warranty or guarantee of any kind, whether express or implied.

2.Assumption of Risk
I understand that automotive repair and maintenance work inherently carry risks, including but not limited to accidental damage to my vehicle, malfunction of parts, or other unforeseen issues. I voluntarily assume all risks associated with the services provided.

3.Release of Liability
I hereby release, waive, discharge, and hold harmless Restoration Ministries, its directors, officers, employees, volunteers, agents, and affiliates from any and all liability, claims, demands, actions, or causes of action whatsoever arising out of or related to any loss, damage, or injury, including any future mechanical issues, that may be sustained by my vehicle or me, whether caused by negligence or otherwise, in connection with the services provided.

4.No Warranty
I acknowledge and agree that the Non-Profit Organization does not provide any warranty, guarantee, or assurance regarding the quality, safety, or reliability of any service performed or any parts used.

5.Indemnification
I agree to indemnify and hold harmless the Non-Profit Organization and its representatives from and against any and all claims, suits, damages, liabilities, costs, and expenses (including reasonable attorney’s fees) arising out of or in connection with the services provided to my vehicle.
By signing below, I confirm that I have read and understood this waiver, that I voluntarily agree to its terms, and that I fully release Restoration Ministries from any liability in connection with the “Grease and Grace” program.

Vehicle Owner Name: ____________________________
Signature: ____________________________
Date: ____________________________

Date*

Date

Signature*