Have you received any Project Home Services?

If so, select those you've received:

House # of stories

Areas that need painting

The exterior of my home is

Can you supply equipment for the paint day? (ladders, paintbrushes, rags, etc.)

Can you or your family help with clean up?

Can you provide refreshments during the day for volunteers? (coffee, soda, etc.)

Can restroom facilities be made available for volunteers?

“Income” means any amount received from the following sources by all household members. Please be prepared to include income documentation (pay stubs, social security letter etc…) and all monthly income by category listed below or your application will not be complete:

Are you or anyone in your household disabled?

Please check the category that represents your ethnic background (response to this question is optional)

In order to solicit volunteers for the Dane County Paint-a-thon, it is crucial that we publicize this event. Would you be comfortable being interviewed about benefiting from the Dane County Paint-a-thon?

By signing below, I recognize that in consideration of my voluntary participation in the Dane County Paint-a-thon, which is a charitable event, I agree to release all sponsoring organizations (including their officers, employees, members, and agents, all other volunteers, and homeowner participants) from all liability whatsoever which may arise out of or be connected with participation in this event and all activities related to it. I certify that I am the current owner of this home and, as such, I am not presently planning to, nor do I intend to within the next two years, sell my home. I understand and agree to have my home painted by volunteers. I, the undersigned, certify subject to disqualification, that this information is true and correct to the best of my knowledge and belief, and that the provisions stated are accepted and agreed to.