Application for Services & Waiver for
Home Owner/Property Owner
National NeighborWorks® Week
*If you have any difficulty formatting this document, please contact: Carol Walker, *
[Name of NeighborWorks® Organization] [Date Of Event], [Time Of Event]
Please return to [name of NeighborWorks® organization] by [deadline date]
During National NeighborWorks® Week, we hold an all day event where volunteers from the community and [name of city] businesses come together to create community gardens, paint homes and renovate previously abandoned buildings. On [day of event], [date of event] hundreds of community and corporate volunteers are expected to turn out for [name of city]’s National NeighborWorks® Week.
If you are interested in participating in this event, the following information is requested. The following information is required before we can schedule your home for any National NeighborWorks® Week project. Your full cooperation is appreciated to help make this a lasting success for this community.
Name of Home Owner
Home Address
Home Phone Work Phone
Family Participants
Names Ages Activities
Names Ages Activities
Names Ages Activities
Names Ages Activities
Have you ever volunteered with a NeighborWorks® organization before?
o Yes o No
Have you ever received services during a previous National
NeighborWorks® Week?
o Yes o No
If yes, when and what services were provided: ______
Did you or a family member participate?
o Yes o No
If not, why did you not participate?
Do you have any physical conditions that may affect your job assignment?
o Yes o No
If so, please explain:
HOMEOWNER, VOLUNTEER and PARENT PERMISSION PARTICIPATION WAIVER OF LIABILITY. “[name of NeighborWorks® organization] National NeighborWorks® Week Project.” In consideration of the opportunity afforded me or my (our) child to assist on a voluntary basis in [name of NeighborWorks® organization] National NeighborWorks® Week activity, a project in which residents and corporate volunteers fix porches, paint houses and beautify blocks and vacant lots in NeighborWorks® organization neighborhoods, and in light of the aims and purposes of the community service provided by NeighborWorks® organization neighborhoods, and in light of the aims and purposes of the community service provided by the [name of NeighborWorks® organization] in organizing this project, I hereby waive any right or cause of action arising as result of my or my (our) child's participation in said project from which any liability may or could accrue against [name of NeighborWorks® organization] or its officers and directors collectively or individually. Without limiting the generality of the foregoing, I agree that this waiver shall include any rights or causes of action resulting from personal injury to me or damage to my property sustained in connection with my activities for the National NeighborWorks® Week Project. (Parental consent needed for participation of all minors (under 18). If applicable, I also grant permission to NeighborWorks® organization volunteers to do work on my property and relieve them of all liability.
Signed this date (month/day/year)
Participant’s Signature
Parental Signature(s) (Needed for Participants under 18)