Skip to Main Content
Loading
Close
Loading
How Do I?
Community
Government
City Services
Visit Cedar Hill TX
Home
Form Centers
Search Forms:
Search Forms
Select a Category
All Categories
Administration
Animal Shelter
City Secretary
Code Enforcement
Court
Fire
Human Resources
Library
Neighborhood Services
Police
Public Works
Utility Billing
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Mission Cedar Hill
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Step One
This section is complete
This section is incomplete
2.
Homeowner Waiver of Liability and Disclaimer
This section is complete
This section is incomplete
Step One
First Name
Last Name
Address
City
State
Zip
Email
Phone Number
How long have you lived at this residence?
Are you behind on your mortgage?
-- Select One --
Yes
No
If you answered yes, how many months behind are you?
Is your home:
-- Select One --
Electric Only
Gas and Electric
Must meet one of the following criteria to receive assistance:
Check all of the following that apply
Handicapped
Veteran/ spouse of a veteran (honorably discharged with from DD214)
Disabled
Single head of household (single parent) with a dependent child living at home
62 years of age or older
How many people currently live in your home?
Please provide their ages and relationship to you
Total household income includes the total of all income from all persons living at the property including wages, retirement, child support, alimony, etc.)
-- Select One --
1- $38,850
2- $44,400
3- $49,950
4- $55,500
5- $59,950
6- $64,400
7- $68,850
8 or more- $73,300
Select total number of occupants
Based on number of occupants, does your TOTAL HOUSEHOLD INCOME fall below the level indicated per number of occupants?
-- Select One --
Yes
No
Numbers adopted from the U.S. Department of Housing & Urban Development-Dallas-Fort Worth- Arlington-FY 2016
Do you have documentation to support your answers?
Yes
No
Are you financially able to pay for house repairs?
Yes
No
Do you own any other properties?
Yes
No
Are you willing to provide copies of this documentation for verification?
Yes
No
Are you going to sell this property within the next 2 years?
-- Select One --
Yes
No
YOUR STORY SECTION
Please describe what repairs you feel are necessary to your home
Please explain your current situation to our team
For example: What circumstances led you to need assistance with home repairs?
Why should your home be considered for this program instead of another one in your neighborhood?
By checking this box I understand that submission of this application does not guarantee that I will qualify for or receive assistance from the Community Restoration Program or any of its' affiliated volunteer organizations. I further understand that more documentation may be required to verify portions of this application
I accept
I decline
Upload photos of work to be completed
Optional
Continue
Homeowner Waiver of Liability and Disclaimer
I hereby acknowledge that I am the legal owner of the property mentioned below in Cedar Hill, TX. 75104 ("Property") and that I have voluntarily agreed to participate in the Community Restoration Program ("Program") for certain construction and/or repairs (collectively the "Work") to the residence located on the Property. I further acknowledge that the Work will be performed at no charge to me by volunteers who will not be compensated for their labor. I am at least eighteen (18) years of age and legally competent to sign this Waiver of Liability and Disclaimer ("Waiver"). I understand that the Program, and Work associated with the Program, involves certain risks that are inherent in such activities, specifically including, but not limited to, property loss/damage, personal injury that may require certain first aid and/or medical treatment, and risks that I may not be able to foresee or anticipate. In consideration of my participation in the Program, I hereby acknowledge that I assume and accept all risks in connection with the Program, and Work associated with the Program, for any harm, injury, or damage that may befall me or my Property as a result of the Program, Work associated with the Program, and/or my participation in the Program, including activities preliminary and subsequent to the Work and the Program, whether foreseen or unforeseen. I understand and agree and hereby acknowledge that I will not attempt to hold the Program or any of the Released Persons (as defined below) liable in any way for any occurrences arising out of the Program, Work associated with the Program, and/or my participation in the Program that may result in injury, death, or other damages to me or my Property. I DO HEREBY EXEMPT AND RELEASE THE CITY OF Cedar Hill, MISSION CEDAR HILL, THE COMMUNITY RESTORATION PROGRAM, ITS STAFF MEMBERS, EMPLOYEES, VOLUNTEERS, CONTRACTORS, AFFILIATES, AGENTS, AND ATTORNEYS (COLLECTIVELY, THE “RELEASED PERSONS”) FROM ANY AND ALL LIABILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH CAUSED BY THE ACTS OR OMISSIONS OF ANY ONE OR MORE OF THE RELEASED PERSONS ARISING OUT OF THE PROGRAM, WORK ASSOCIATED WITH THE PROGRAM, OR MY PARTICIPATION IN THE PROGRAM, SPECIFICALLY INCLUDING, BUT NOT LIMITED TO, ANY SUCH LIABILITY ARISING OUT OF A CONSTRUCTION DEFECT, WHETHER LATENT OR NOT LATENT, CAUSED BY THE NEGLIGENCE, GROSS NEGLIGENCE AND/OR WILLFUL OR INTENTIONAL MISCONDUCT OF ANY ONE OR MORE OF THE RELEASED PERSONS, OR THE BREACH OF ANY WARRANTIES, WHETHER EXPRESS OR IMPLIED, ARISING OUT OF COMMON LAW, CONTRACT, OR STATUTE, SPECIFICALLY INCLUDING, BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, FITNESS, REPAIR, HABITABILITY, SUITABILITY, CONSTRUCTION, AND SERVICES PERFORMED IN A GOOD AND WORKMANLIKE MANNER. Homeowner Waiver of Liability and Disclaimer Page 1 of 2 I FURTHER HEREBY ACKNOWLEDGE AND AGREE TO DEFEND, INDEMNIFY, SAVE, HOLD HARMLESS, AND COVENANT NOT TO SUE THE RELEASED PERSONS FOR ANY AND ALL CLAIMS, DEMANDS, DAMAGES, CAUSES OF ACTION AND SUITS IN EQUITY, WHETHER ARISING OUT OF COMMON LAW, EQUITY, ARBITRATION OR STATUTE, NOW OR HEREAFTER ARISING, KNOWN OR UNKNOWN, ASSERTED BY ME AND/OR MY ESTATE, HEIRS, EXECUTORS, ADMINISTRATORS, OR ASSIGNS) ARISING OUT OF THE PROGRAM, ASSOCIATED WITH THE PROGRAM, OR MY PARTICIPATION IN THE PROGRAM, WHETHER SUCH CLAIMS, DEMANDS, DAMAGES, CAUSES OF ACTION AND SUITS ARISE OUT OF A CONSTRUCTION DEFECT, WHETHER LATENT OR NOT LATENT, THE NEGLIGENCE, GROSS NEGLIGENCE AND/OR WILLFUL OR INTENTIONAL MISCONDUCT OF ANY ONE OR MORE OF THE RELEASED PERSONS; OR THE BREACH OF ANY WARRANTIES, WHETHER EXPRESS OR IMPLIED, ARISING OUT OF COMMON LAW, CONTRACT, OR STATUTE, SPECIFICALLY INCLUDING, BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, FITNESS, REPAIR, HABITABILITY, SUITABILITY, CONSTRUCTION, AND SERVICES PERFORMED IN A GOOD AND WORKMANLIKE MANNER. I also hereby grant and convey unto the Community Restoration Program all right, title, and interest in any and all photographic images and video or audio recordings made during the Program and/or Work associated with the Program, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I hereby acknowledge and expressly agree that all indemnities, releases, and waivers contained in the Waiver are intended to be as broad and inclusive as permitted by the laws of the State of Texas and that, if any portion of the agreements in this Waiver are held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This Waiver contains the entire agreement between me and the Community Restoration Program regarding the Program, work associated with the Program, and my participation in the Program. I understand the terms herein are contractual and not merely recitals, and that I have signed this document of my own free will.
Property Address
Full Name of Applicant
Consent
I accept
I decline
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS WAIVER BY READING IT BEFORE I CONSENT
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
|
Go Back
* indicates a required field
Agendas and Minutes
City Ordinances
City Staff Directory
Employment
Notify Me
Online Services
Photo Galleries
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow