City of Nampa Form Center

2. 
4. Thank you for committing to help Nampa's seniors and disabled residents in need. With your help, we are able to make an impact on the residents of Nampa one house at a time. As available, we will provide you with information about the home and owner(s) your team is matched with.
6. Team Name:*
7. Team Leader:*
8. Phone Number(s):*
10. Email:*
11. Contact Preference:*

    1. Phone
    2. Email
13. Secondary Contact:*
14. Secondary Phone Number(s):*
15. Secondary Email:*
19. Photos of my team may be taken for publicity purposes.*

    1. Yes
    2. No
20. Approximately how many people on team?*
24. Please choose the best description of your team so that we can do our best to match you with property needs:*

    *A team should have a minimum of 10 members to be successful without wearing yourselves out.

    1. Very Capable - can take on a larger project
    2. Average - some with and without experience. Do not want a huge project, but can do more than a mobile home.
    3. Small or Inexperienced - Would prefer a small project like a mobile home or to partner with another team.
    4. Partial Team - will need partnered with another team.
26. Is your team willing to be partnered with another team based on the needs of the assigned home?*

    1. Yes
    2. No
27. Brush-Up Nampa is funded through generous community sponsorship. Is your team able to sponsor the home you work on through your organization?*

    1. Yes
    2. No
31. Electronic Signature
    By checking the box and entering your information below, you hereby declare, under penalties of perjury, that you are authorized to submit the information in this form and to the best of your knowledge, it is true, correct and complete. I have read the above acknowledgement and have advised my team of lead safe paint practices.
33. 1. Signature
34. First Name*
35. Last Name*
36. Date*
    Date
40. Team Name:*
    ALL VOLUNTEERS PLEASE READ AND SIGN BELOW
42. In consideration of the opportunity afforded me and/or my child to assist Brush-Up Nampa on a voluntary basis, I hereby waive any rights or case of action arising as a result of my or my child's participation in said project from which any liability may or could occur against Brush-Up Nampa officers and directors collectively or individually, event sponsors, donors, volunteers, or homeowners. Without limiting the generality of the foregoing, I agree that this waiver shall include any rights or causes of action resulting from personal injury to me or my child sustained in connection with my activities for Brush up Nampa. (Parental consent needed for all minor (under age 18) participation)
44. Electronic Signature
    By checking the box and entering your information below, you hereby declare, under penalties of perjury, that you are authorized to submit the information in this form and to the best of your knowledge, it is true, correct and complete.
46. Check To Sign

    1. Signature
47. Full Name
48. Home Address
49. Email
51. Check To Sign

    1. Signature
52. Full Name
53. Home Address
54. Email
56. Check To Sign

    1. Signature
57. Full Name
58. Home Address
59. Email
61. Check To Sign

    1. Signature
62. Full Name
63. Home Address
64. Email
66. Check To Sign

    1. Signature
67. Full Name
68. Home Address
69. Email
71. Check To Sign

    1. Signature
72. Full Name
73. Home Address
74. Email
76. Check To Sign

    1. Signature
77. Full Name
78. Home Address
79. Email
81. Check To Sign

    1. Signature
82. Full Name
83. Home Address
84. Email
86. Check To Sign

    1. Signature
87. Full Name
88. Home Address
89. Email
91. Check To Sign

    1. Signature
92. Full Name
93. Home Address
94. Email
98. If you have questions, please call 208-468-5472 or email [email protected]
Leave This Blank:


100. 1. Receive an email copy of this form.
101. Email address

     This field is not part of the form submission.

102. Submit

* indicates a required field