Firewood Application

1. Voluntary Participation:

2. Agreement:

3. Agreement:

4. Agreement:

5. Agreement:

6. Agreement:

7. Agreement:

not an emergency-based program

8. Agreement:

9. Agreement:

not request wood more than needed.

request wood no more than every 2 weeks.

10. Release:

I understand that trucks and trailers may cause damage in my yard, especially if the ground is wet.
I understand that it is my responsibility to point out to volunteers upon each delivery any hazards in my yard that should be avoided, such as the location of a septic tank.
I understand that contact with anyone leads to the possibility of exposure to illness. Due to the highly contagious nature of COVID-19 and its , even with use of recommended handwashing, facemasks, and distancing, it is impossible to fully eliminate the risk of exposure to illness. I will do my part to minimize exposure to COVID 19 and other illnesses by maintaining recommended guidelines for disease prevention at the time volunteers deliver.

In consideration of the opportunity to participate in CommunityWorx, I release CommunityWorx, its volunteers, and its partners from any liability suffered by my family, property, or myself during the delivery of firewood.

11. Knowing and Voluntary Execution:I have read this agreement and fully understand its contents. I am aware that this is a release of all liability and I sign it of my own free will.

Name	Relationship to Client	Age	Source for Income	Actions

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Firewood Main Application

List all adults and children in the home and their source for income

Home Ownership

Land Ownership

Renting Home

Renting Lot

Client Liability Release & Agreement for Firewood

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