Needs Request Form

Name

This address will receive a confirmation email

Phone

Description of Need(s)

How long have you attended HighPoint?

<1 year 1-3 years 4+ years

Respectively, please choose from the following descriptions about yourself:

I am a widow/widower I am a single mom I am 60+ years of age I have extenuating circumstances

Are you capable of helping with the work?

Yes No

Describe your Extenuating Circumstances (if selected)

Please, describe how you have attempted to address the needs you have prior to submitting this form:

Disclaimers

Do you understand that you will be responsible for providing resources to accomplish the task?

Yes, and I am ready to provide needed resources. Yes, but I am unable to provide all resources. I do not have the capability to provide resources.

Do you understand that the completion of this form does not guarantee your request will be fulfilled by HighPoint Church?

Yes, I understand

Do you understand that this is a ministry effort, and we cannot guarantee a specific timeline or level of quality? You agree to not hold HighPoint Church, nor our representatives, responsible for the work completed or under-completed.

I understand and agree.

Do you understand that we have a right to refuse any request of work and to cancel our agreement to fulfill a need, when necessary?

Yes, I understand.

Description

This form is for those of you who are widows/widowers, single moms, senior adults, or experiencing life circumstances that keep you from being able to fulfill physical needs. You may be facing some of the following:

- Home repair
- Automotive repair
- Assembly Needs
- Lawn Needs

If you have a need that requires skills/abilities you do not have available to you, we want to do our best to help or give you the best next step. We cannot guarantee that we can help, but we will do what we can to help you.

Please allow 14 days for response.

Needs Request Form

Description

Please Fix the Following