FORM B
Rebuilding Together 2017
Homeowner Agreement: House No.______
I give permission for Rebuilding Together and its volunteers to performRepairs and improvements on my home located at:
______
StreetCityStateZip Code
I understand that Rebuilding Together is a volunteer program and that promises cannot be made as the specific work that will be done.
The general plan for repairs and improvements has been explained to me, but I give Rebuilding Together and it's volunteers full authority to determine the extent and types of repairs to be performed. Improvements will be performed free of charge, and Rebuilding Together and its volunteers disclaim all warranties, expressed or implied concerning the repairs. Volunteers, some or all of who may be unskilled, will perform the repairs and improvements.
I agree that I will cooperate with the House Captain and the volunteer team. I will assure that all able-bodied relatives or friends present on the project day will work with the other volunteers. If they are unwilling to work they will be asked to leave. If they fail to comply with this policy, the House Captain has the right to stop the work and remove the volunteers from the property. Any and all work started on the home will be left unfinished.
I understand that the repairs and improvements will be made on April 29th, 2017, but some preparation may be necessary prior to that date.
In consideration of the repairs and improvements, I further hold Rebuilding Together, its officers, directors, employees, agents, donors, volunteers, and other affiliates, collectively and individually harmless from any claims and liabilities arising at any time as a result of the repairs, including, without limitation, any rights or causes of action resulting from personal injury or death, or damage to my property, directly or indirectly arising from any improperly performed repairs or improvements or defects in material or workmanship.
I also grant Rebuilding Together, permission to take or have taken, still andmoving photographs and films including television pictures of my home. I consent and authorize Rebuilding Together, its advertising agencies, news media or other persons interested in Rebuilding Together, to use and reproduce the photographs, films and pictures and to circulate and publicize the same by all means including, without limiting the generality of the foregoing, newspapers, television media, brochures, pamphlets and other materials.
No inducements or promises have been made to me to secure my signature to this release other that the intention of Rebuilding Together to perform the repairs and improvements and to use such photographs, films and pictures for the primary purpose of promoting and aiding its program and its works.
The Owner(s) hereby acknowledge(s) they have been provided with a copy of the “PROTECT YOUR FAMILY FROM LEAD IN YOUR HOME” pamphlet.
Signed this ______day of ______2017.
Homeowner: ______Witness: ______
Homeowner: ______Witness: ______
Part 2: Completed Only By Occupants Residing in Properties Built Before 1978
By signing and dating Part 2 of this form, the Owner listed below certifies that they received a written “Notice of Presumption of Lead-Based Paint” for the property above.
Signature of Occupant: Date: