ALERTS
News
Volunteer
Donate
Facebook
Instagram
Linkedin
Get Help
Adult Education
Dental Care
Disaster Outreach
Eastern Oklahoma Outreach
Emergency Assistance
Food
Healing After Abortion
Healing From Abuse
Immigration Legal Services
Kitchen & Garden Ministries
Madonna House
Maternity Care
Porta Caeli House
St. Elizabeth Lodge
Workforce Development
Other services information:
Adoption Services
Counseling
Give Help
Donate
Estate Planning
Volunteer
Cooking Up Compassion
Who We Are
About Us
FAQ | Did you know?
Our Board
Our Staff
Careers
News
Newsletters
Annual Reports
Strategic Plan
Share Your Story
Non-Discrimination Statement
Child/Youth Protection
Locations
Bartlesville
Broken Arrow
McAlester
Muskogee
Sallisaw
Tulsa
Wilburton
Contact Us
CAR CARE CLINIC INTAKE FORM
Application for Car Care Services
Referring Program (Choose Client if you are unsure)
Client
Transitional Living
Case Management
Facilities
Name
(Required)
First Name
Last Name
Phone
(Required)
Case Managers Name
(Required)
Year, Make and Model of Vehicle
(Required)
Please describe your concern with the vehicle, or the services you would like performed
(Required)
Liability Release
(Required)
For and in consideration of the performance of the Work described in Section III herein, I, the above-described Owner for myself, and on behalf of my heirs, next of kin, and any legal and personal representatives, executors, administrators, successors and assigns, hereby agree to and make the following contractual representations pursuant to this Waiver, Release of Liability Hold Harmless, and Service Agreement (the “Agreement”). 1. Owner Representations. I hereby represent that (i) I am the registered Owner of the Vehicle described In Section II herein; and (ii) I have the authority to authorize automotive work and repairs to be performed on the Vehicle. 2. Owner Acknowledgments. I understand that (i) the Work, as described in Section II herein will be performed by Catholic Charities Volunteers who are amateur mechanics; (ii) the Work will be performed as part of a charitable gift to the owner from Catholic Charities; (iii) no payment or tipping for the Work is permitted; (iv) any testing deemed necessary by the Car Care Coordinator is hereby authorized; and, (v) the Car Care Coordinator can decline to perform the Work on the Vehicle for any reason whatsoever at the Instructor’s discretion. 3. Waiver, Release of Liability, & Hold Harmless. I hereby Release, Waive and Covenant Not to Sue, and further agree to Indemnify, Defend and Hold Harmless the following parties: Catholic Charities of Eastern Oklahoma, its respective members, agents, employees, officers, directors, servants, representatives, volunteers, successors, affiliates and assigns (individually and collectively “Released Parties”), with respect to any liability, claim(s), demand(s), cause(s) of action, damage(s), loss or expense (including court costs and reasonable attorneys’ fees) of any kind or nature (“Liability”) which may arise out of, result from, or relate in any way to the Work performed on the Vehicle, including claims for Liability caused, in whole or in part, by the negligent acts or omissions of the Released Parties. I further agree that if, despite this Agreement, any third-party makes a claim for Liability against any of the Released Parties, I will indemnify, defend and hold harmless each of the Released Parties from any such Liabilities which any may be incurred as the result of such claim. I hereby warrant that I am of legal age and authorized to enter into this Agreement as the Owner of the Vehicle described herein, that I have read this Agreement carefully, understand its terms and conditions, acknowledge that I will be giving up substantial legal rights by signing it, acknowledge that I have signed this Agreement without any inducement, assurance or guarantee, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions and provisions of this Agreement. This Agreement represents the complete understanding between the parties regarding these issues and no oral representations, statements or inducements have been made apart from this Agreement. If any provision of this Agreement is held to be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions.
I acknowledge, understand, and release Catholic Charities from Liability
Untitled
Untitled
Phone
This field is for validation purposes and should be left unchanged.
Alerts
Services
Volunteer
Donate
Notifications