Operation Weatherization

OPERATION WEATHERIZATION

Let us help you get ready for winter.

Heart of Indiana United Way is offering FREE Do-It-Yourself weatherization supplies for clients of the THRIVE Network or any other United Way community partners.

Supplies include:

Tubes of acrylic caulk
Plastic window insulation kits
Can of spray foam insulation
Peel and stick door sweeps
Roll of heavy plastic for outside windows
Blanket
Water heater kit
Set of Instructions

You must reside in Delaware, Fayette, Henry, Madison, or Randolph County.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone

Home Phone

If needed, I prefer to be:

Emailed
Texted
Called

Name of Organization that Referred You to this Program *

Total # of people in household (including self) *

Total # of people 60 & over (including self, if applicable)

Total # of children 12 years & under

Total # of children 13-17 years

Choose a Location & Date to Pick Up Your Supplies *

Muncie, FRI 11/17, 12-3 pm - Ross Community Center, 1110 West 10th St
Please contact me to make arrangements for pickup or delivery.

You will receive a reminder message about your pick up time.

Please select your kits:

Main Kit - 4 indoor plastic window kits, 3 peel & stick door sweeps, 2 rolls of duct tape, 1 blanket
Sealing Kit - 1 can of spray form insulation, 2 tubes of caulk

Operation Weatherization Neighbor Release and Waiver of Liability

By checking this box, I agree that I am the legal occupant and/or authorized person of the property on which the weatherization supplies and/or activity work is to be performed and have full authority to enter into this agreement. I understand the work entails risk. I accept the conditions under which each activity is conducted, and I accept and assume all risks inherent in each of these activities, including property loss/damage, personal injury (fatal or otherwise), and including those risks I may not foresee or anticipate. I hereby agree to release, hold harmless and indemnify any person or organization that participates in any way in planning and/or executing this program, including its advisors, sponsors and volunteers from any and all liability, costs, claims, losses, or damages arising from, or in any way related to, my participation in this project. I agree that my electric and gas utility provider(s) may release to the Heart of Indiana United Way usage data for the address listed on this application. Also, I understand that supplies are limited and not guaranteed.

Completed by Caseworker

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OPERATION WEATHERIZATION

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