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2. Mennonite Disaster Service (MDS) provides volunteer labor to property owners for disaster recovery projects. MDS will assign volunteers as they are able to complete the labor described below when building materials are provided.

4. Homeowner's last name*
5. Homeowner's first name*
7. Address of damaged property*
9. City*
10. State
11. Zip code
13. Email
14. Phone number*
16. Job designation*

    1. Cleanup/temporary repairs
    2. Cut up trees and move to roadside
20. Signature of Understanding

    Release of Information: I hereby give MDS permission to give/obtain information about me and the property described above to/from the Red Cross, FEMA/EMO, state and local agencies and/or other private disaster relief agencies. This information will be used only for the purposes of completing this job and will not be sold or given to mailing lists by MDS.

    Release form Liability: I give permission to MDS and its volunteers to work on the property described above. I am the homeowner and have full authority to authorize any repairs, renovations or alternations to the property and I have full authority to enter into the terms of this agreement. I acknowledge that MDS is providing volunteer services free of charge. In consideration of these services, I, together with my heirs and assigns, full release MDS, all affiliates and all MDS employees, agents and volunteers from any and all demands, claims, or liability for any bodily injury, damages to the property, loss, accident, or irregularity related to the job. In, sum, I fully agree that I will not sue MDS or anyone affiliated with MDS for any reason associated with the services and materials provided with respect to the above described job.

22. Media Release

    I give permission for MDS to use my name and likeness (and my family who live with me) in photographs, videos, and/or print materials for publication by MDS. This includes digital, social media, and online accounts and channels owned and/or operated by MDS (such as newsletters, annual reports, websites, social media posts, blog posts, etc.). I understand that MDS is not responsible or liable for the content of digital accounts which it does not own and/or operate.

    1. Yes
    2. No
24. Electronic Signature
25. Date
    Date
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field