Survey – The ReCARES Network

(this is old 2023): Please click here to take our demographics survey. Thank You. (this is the old (early 2023) survey)

2024.10[draft] Customer Data Collection & Waiver: Name/Contact info/Liability Waiver. (this will assign a unique contact number (can be used for ReCARES eligibility #)

Contact Form & Liability Waiver

First

Last

Street Address

City

State

Zip code

Phone Number

Are you here on behalf of:

Yourself

A Friend

A Client (please add your agency name below)

End user Name

Agency Name

Comment or Message

Liability Waiver: waiver text … lorem ipsum….. …other legal words etc. etc. …..and I hereby agree to indemnify and hold harmless ReCARES, its Directors, Staff, and Volunteers with respect to any injury, defect, misuse, unsuitability, or any other issue caused by or in conjunction with any equipment, product, supplies or item donated to or received from The ReCARES Network today and/or in any future transactions.

Virtual Signature

By checking this box I am providing my virtual signature in agreement to the above liability waiver.

Liability Waiver: All recipients must have a (digitally)signed lability waiver on file.

Demographics Survey: This information is collected and stored anonymously. It will not affect your eligibility for, or services received from ReCARES. We collect this data from our Donors and Recipients because it helps in our fundraising efforts to let our grantors and funders know how their resources are being used. We thank you for taking the time to fill out the information.

(Please complete only once per person) (In the case of a friend/agent picking up – use best case info regarding the end user.)