After clicking the Submit button below, you will be taken to a page to electronically sign your application. By doing so, you are agreeing to both of the NFCC Release and Waiver of Liability as written below as well as the GA HMIS Client Authorization Form below.
Release and Waiver of Liability
This Release and Waiver of Liability (the Release sets forth certain terms and respect to Applicants request for certain assistance and services and is executed in favor of North Fulton Community Charities, a nonprofit corporation, its directors, officers, employees, volunteers, agents, successors, and assigns (collectively, "NFCC"). Applicant desires for NFCC to provide certain assistance and services. Applicant's signature below indicates Applicant's acknowledgement and agreement, without duress, to the following terms:
WAIVER AND RELEASE. Applicant does hereby release forever discharge and hold harmless NFCC from and all liability, claims and demands of whatever kind, either in law or in equity, which arise or may hereafter arise from NFCC's activities for or on behalf of Applicant. Applicant understands and acknowledges that this Release discharges NFCC from any liability or claim that the Applicant may have against NFCC that may result from NFCC's activities for or on behalf of Applicant and/or Applicant's minor children, if applicable whether caused in whole or in part by Applicant's negligence or the negligence of NFCC.
ASSUMPTION OF RISK. Applicant understands that the food NFCC distributes is donated to NFCC by third parties. In connection thereto, Applicant assumes all risk of accepting and consuming such food and releases NFCC from all liability resulting from the consumption of such food.
DISCLOSURE OF INFORMATION. Applicant understands and agrees that all personal information provided by Applicant to NFCC, whether provided through the Application for Assistance, through other written communication or verbally, may be shared with third party service providers that conduct activities related to the type of assistance and services provided by NFCC.
OTHER. Applicant expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Georgia, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Georgia. Applicant agrees that in the event that any portion of the release is held to be invalid, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this release, which shall continue to be enforceable.
IN WITNESS WHEREOF, Applicant has read and voluntarily signed this Release, and further agrees that no oral representations, statements, or inducements apart from the foregoing written agreement have been made.
GA HMIS Client Authorization Form
I understand that North Fulton Community Charities is part of the Fulton Continuum of Care and participates in the Georgia Homeless Management Information System (GA HMIS) also known as Client Track. This agency has my permission to obtain any information regarding me in the Client Track system and to enter in the system information that I supply to this agency concerning my situation and my need for assistance. I understand that agencies in the network will keep this information confidential. I also understand that staff at each participating agency is required to receive regular training on client confidentiality and social services best practices. GA HMIS Collaborative Client Data Sharing Opt Out Form and Privacy Policy available upon request.
