Specialized Skills and Equipment Donation Form

Thank you for your interest in helping out in your community! Please fill the form out completely so that we can contact you when we need you.

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Personal Info

Person or Business Name

Name *

Phone Number *

Email *

Skills or Equipment you can offer *

What specialized skills or equipment do you have? Examples: heavy equipment license, PPE, tools

Availability *

Please let us know quickly you can be available? Within hours, 24 hrs? A week?

Location

Where are you (or equipment or item) located?

Other Location

Describe any location not already listed.

I Agree *

In consideration of the acceptance by the City of the offer of assistance during the COVID-19 disaster, I hereby waive, release and discharge any and all claims for damages for death, personal injury, or property damage which I may have, or which may hereafter accrue to me as a result of my participation in such assistance. This release Agreement is intended to discharge in advance the City of Homer, its City Council, officers, agents, and employees from and against any and all liability arising out of or connected with my participation in said assistance, even though that liability may arise out of NEGLIGENCE or CARELESSNESS, on the part of the persons or entities mentioned above. I AM AWARE THAT ASSISTANCE MAY SUBJECT ME TO PHYSICAL RISKS AND DANGERS. NEVERTHELESS, I VOLUNTARILY AGREE TO ASSUME ANY AND ALL RISKS OF INJURY OR DEATH, AND TO RELEASE, DISCHARGE, AND HOLD HARMLESS ALL OF THE ENTITIES OR PERSONS MENTIONED ABOVE WHO, THROUGH NEGLIGENCE OR CARELESSNESS, MIGHT OTHERWISE BE LIABLE TO ME, OR MY HEIRS, PERSONAL REPRESENTATIVES, RELATIVES, SPOUSE OR ASSIGNS. It is understood and agreed that this waiver, release, and assumption of risk is to be binding on my HEIRS, PERSONAL REPRESENTATIVES, RELATIVES, SPOUSE and ASSIGNS and is intended to be as broad and inclusive as is permitted by the laws of the State of Alaska and that if any portion of this Agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I have carefully READ this Agreement and agree with its content.

City of Homer's COVID-19 Updates

Specialized Skills and Equipment Donation Form

Contact Information

CDC Guidance