Name *

First Name

Last Name

Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Program Participation Terms *

By submitting this application, the homeowner agrees to the following: Liability Waiver: I, the homeowner listed above, hereby release, waive, discharge, and covenant not to sue High 5 Birmingham, its partners, volunteers, and the Birmingham-Jefferson Convention Complex (BJCC) and its partners, for any and all liability, claims, demands, actions, or causes of action whatsoever, which may arise in connection with participation in the 100 Doors Program. This release includes, but is not limited to, any injury or damage to property caused during or resulting from the painting of my home’s front door.

I understand and agree

Homeowner Responsibility: *

I understand that I am responsible for ensuring my door is clean and ready for painting prior to the scheduled painting date. The door must be free of dirt, debris, or excessive damage to ensure proper painting and the success of this project. If the door is not ready for painting, the program reserves the right to cancel or reschedule the service.

I understand and agree

Program Participation: *

I confirm that I am the homeowner and the individual completing this application. I understand that the painting will only take place on the front door of my home and that the program does not provide additional services beyond painting. I also understand that the home must be occupied.

Yes, I am the homeowner and the home is occupied

No, I am not the homeowner

Program Volunteering: *

I acknowledge that volunteers participating in this program will assist with the door painting and that their actions are done in the spirit of community service. The volunteers who will be painting the doors are not professional painters. I agree to cooperate with volunteers and High 5 Birmingham’s team during the process.

I understand and agree

Indemnification: *

I agree to indemnify and hold harmless High 5 Birmingham, its partners, volunteers, and the BJCC and its partners, from any and all claims, demands, or lawsuits arising out of my failure to follow these terms or from damages resulting from my participation in the 100 Doors Program.

I understand and agree

I understand that completion of this application does not guarantee that my home will be selected for inclusion in the 100 doors program. The program will select as many homes as possible for inclusion. Front doors that are damaged and cannot be safely painted may not be included in the program. *

I understand and agree

I understand that there is always a possibility that I may not like the color that I select at the completion of this project. High 5 Birmingham, it's partners, volunteers and the BJCC and it's partners cannot be held responsible for dislike of colors on the door at the completion of the project. *

I understand and agree

If included in the program, I wish for my door to be painted the following color: *

Colors can be found at the top of this application.

Caicos Turquoise

Laser Lemon

Mega Blue

Cellini Gold

Red Pepper

Maple Glaze

Live Jazz

Typing my name below serves as my electronic signature and confirms that I understand and agree to all terms and conditions of the application and have provided information that is accurate. By signing this electronically, I understand that if I am not the homeowner of the home identified in this application, that I may be held legally liable by the true homeowner for participation in this program. *

First Name

Last Name