I/we certify that the information on this application is accurate and that I own the property at the address given on this application. I/we understand that if I have not answered the questions truthfully, my application may be denied, and that even if I have already been selected to receive a Habitat home repair, I may be disqualified from the program. I/we understand that by filing this application, I am authorizing Habitat for Humanity Quad Cities to evaluate my need for a home repair. I understand that the evaluation could include personal visits, inspections, background check, financial information and employment/income verification.

If selected for this program, I/we understand that an agreement will be signed for the terms and conditions of the program, approving the scope of work and agreeing to the repayment plan (if applicable).

I/we also understand that, depending on the repair, the people who work on my house may be unpaid volunteers and that Habitat for Humanity makes no warranties, expressed or implied, regarding any materials used or work done by anyone at my house. I/we hereby agree that I, my assignees, their heirs, guardians or legal representatives will not make a claim against, sue or attach the property of Habitat for Humanity Quad Cities for injury or damage resulting from negligence or other acts, howsoever caused damage resulting from negligence or other acts, howsoever caused by any employee, agent, contractor of or participant in Habitat for Humanity Quad Cities’ activities.