Chaverim LA Service Waiver

First Name

Last Name

Email

Phone

Responding unit # (ask the volunteer helping you)

Service type requested

Auto ownership verification

Yes, it's my vehicleNo, but I have permission to use itIt's a rental and I have the rental agreementIt's a rental and I do not have the rental agreementI do not have any way to verify it

Home ownership verification

I own the property and have ID matching the addressI own the property but do not have ID matchingI lease the property and have ID matchingI lease the property and do not have ID matchingI have permission to enter, but am not on any paperworkI do not have any way to verify itOther, I can explain when you arrive

In consideration of Chaverim of Los Angeles providing the service requested above, I hereby release, indemnify, and hold harmless Chaverim of Los Angeles and its volunteers from all claims, demands, and causes of action of every nature, including those relating to negligent acts, arising from the provision of such services. I understand this service involves risk of damage to my vehicle or home and expressly accept that risk. Chaverim is not affiliated with Hatzolah. By submitting this form I also agree to opt in to the Chaverim LA email list.

I have read and agree to the terms above

Signature

Sign above