Holiday Help Family Application


    Head of Household Information:




    Dependent Information

    Household Income

    Personal Information


    Declaration of Need and Risk/Release Waiver

    In consideration of being permitted to participate in the Good in the ‘Hood Holiday Help program, on behalf of myself, or a minor child or ward, heir, next of kin, personal representative, successor or assign;

    1. I ACKNOWLEDGE, UNDERSTAND AND DECLARE THAT:

      • To the best of my knowledge, I am in a state of economic and/or personal hardship and in need of the support being offered through the programs associated with Good in the ‘Hood.
      • I commit to use the programs and gifts for the purpose intended and will not sell, barter, or trade the gifts and commodities received through my association with Good in the ‘Hood.


    2. I ASSUME ALL OF THE ABOVE RISKS AND RELEASE, WAIVE, DISCHARGE, HOLD HARMLESS, INDEMNIFY AND COVENANT NOT TO SUE:

      1. Good in the Hood and/or other affiliated partners, other volunteers, and sponsors FROM ANY AND ALL LIABILITY FOR INJURY, INCLUDING DEATH, EMOTIONAL TRAUMA, AND LOSS OR DAMAGE TO ME OR MY PROPERTY, OR ANY OTHER CONSEQUENCE in connection with my participation with “Good in the ‘Hood”.


    3. My family and I CONSENT TO:

      1. ALLOW our PHOTOGRAPH(s), PICTURE(s), LIKENESS(es), VIDEO and/or VOICE(s) to be used for Good in the Hood and our program partner materials and promotions.
      2. Meet with our sponsors in order to receive any gifts/commodities being offered.


    4. I TESTIFY THAT ALL INFORMATION IN THIS APPLICATION IS ACCURATE AND CORRECT TO THE BEST OF MY KNOWLEDGE.