Repair application

Not sure whether we can help with your repair? Read how it works first. All fields are required unless noted.

How did you hear about us? (optional)

If you were referred by an agency, please include name and phone number (optional)

Your information

Information about your car

Year/Make/Model of carVIN numberYou will not get a callback if you do not provide the VIN number.Mileage

Is the vehicle registered in your name?

You will be required to submit a picture of your title/registration.

YesNo

Please check if this is

Routine maintenanceRepair

Please describe in detail the work you are requesting or the problem you are havingKeep in mind that our ministry can only provide labor for minor auto repairs and/or maintenance. We do not have funds to assist with the purchase of parts.

Acknowledgements

I understand the Auto Repair Ministry is limited to repairs that can be completed in a few hours, and the ministry will have to review the repairs needed to determine if they are within the ministry's scope.I understand the Auto Repair Ministry can refuse to make any repairs if they determine the vehicle is unsafe to drive. I understand this decision is not made lightly and is made with the client's best interests in mind.I understand the Auto Repair Ministry receives more requests for help than they can make.It is my responsibility to confirm by Wednesday evening the week of the repair that I will be participating. The Auto Repair Ministry will also send a reminder. However, in the event my contact phone number is not working, I will call or text from another phone so our administrative coordinator can confirm.If you should no-show for your appointment, you will no longer be eligible to receive services from the Auto Repair Ministry. A no-show is defined as (1) not confirming the week of my repair; (2) confirming the week of my repair and not arriving at my scheduled time; (3) cancelling late Friday evening or Saturday morning.It is my responsibility to stay with the vehicle while repairs are made. I cannot drop off my vehicle or leave the church campus.I understand the mechanic team will provide me with a parts estimate prior to buying parts, and I will reimburse the ministry with cash, check or credit/debit card.I have reviewed the data provided and attest that it is accurate and true.I understand, in consideration of receipt of voluntary services from the participants of the Give Love Project Auto Repair Ministry sponsored by Next Level Church, I hereby release and agree to hold harmless and indemnify Next Level Church, it's employees, classes, organizations, members, attendees, trustees, officers and agents from and against any and all liability, claims, demands, actions, damages, expenses and costs, including attorney's fees and loss of judgments of whatsoever kind and nature which may result from or arise out of services provided for me or for such services which may benefit me whether or not resulting, in whole or in part from the negligence or from acts of omissions of either the participants in the Give Love Project Auto Repair Ministry of Next Level Church, it's employees, classes, organizations, members, attendees, trustees, officers and agents.