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Homeowner Help Application

To qualify for the Christmas in October program, you must:

1) Own only one residence (the home in which you currently live) and

2) Lack the finances or resources to have the repairs completed.


In addition, you must meet ONE of the following 3 criteria:

1) Be age 62 or older; or

2) Have a physical disability; or

3) Be a veteran or have a veteran residing in your home

Is anyone in the home disabled?
Yes
No
Is anyone in the home a veteran?
Yes
No

General information about your home:

Basement
Yes
No
Have you received help from Christmas in October before?
Yes
No
Please check all boxes that are needed

Christmas in October Waiver of Liability


The undersigned, _____________________________________(homeowner), hereby releases and forever discharges the officers, directors, agents, employees, volunteers and representatives of the Christmas in October Program, as well as the municipal government in which the home is situated, including, but not limited to, the City of Kansas City, Kansas, the City of Kansas City, Missouri, and the persons or entities providing materials or labor to the rehabilitation or renovation work provided to the undersigned homeowner, from all claims, demands, actions and causes of action relating to any injury or loss which the undersigned may sustain in any way connected with the undersigned’s home participating in the Christmas in October program. The undersigned agrees and understands that the undersigned is to assume all the risks and grant this release in consideration for whatever rehabilitation or renovation work is provided to the undersigned’s residence. The undersigned fully understands that all work provided is on a voluntary basis and the undersigned agrees to accept whatever work is provided. The undersigned understands that no promises or assurances have been made that any particular work will be done or that any particular result will be achieved. The undersigned also understands that the Cities of Kansas City, Kansas, and Kansas City, Missouri, will not be inspecting any work done by volunteers from Christmas in October. As one of the Christmas in October program participants, the undersigned, as well as all other residents in the home, authorize Christmas in October to use and/or publish any and all photographs or video taken the day of the event to use for reporting and/or marketing purposes (i.e., sales and marketing collateral, website, published reports, etc.). The undersigned fully understands the meaning of the terms of this release and the undersigned has freely agreed to be bound by its terms.

Date
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