Please read this before completing the Request for Services and Release Form (below)

Love INC of Shelby County is committed to protecting your privacy while also coordinating with community partners to help meet your needs. By signing below, you authorize Love INC to use and share the information you provide for the purpose of resourcing and supporting you and your household.

Information you provide to Love INC may include your name, address, phone number, and a description of your situation and needs. Love INC will not request or require you to provide medical or other sensitive information through our website.

Love INC may share your information with churches, nonprofits, community organizations, government offices, and individual volunteers in order to connect you with resources and services. Only the minimum necessary information will be shared to assist you.

The purpose of sharing your information is to connect you with resources such as food, clothing, housing, utilities, counseling, classes, mentoring, or church ministries. This may also include follow-up calls to evaluate whether needs were met and to explore long-term transformation opportunities.

VOLUNTEER-ASSISTED HELP
Some needs may be met by individuals in our community who voluntarily choose to help after Love INC makes a connection.

If you request or accept this kind of help, you authorize Love INC to share the minimum information reasonably necessary with a potential or confirmed volunteer so the need can be discussed and, when appropriate, coordinated.

Please tell Love INC about any known condition that could reasonably affect the safety of someone coming to your home, property, or another location to help. This may include unsafe property conditions, animals, access concerns, or other circumstances relevant to the requested help. You agree to provide reasonable and safe access for the help being provided and to secure animals when appropriate.

Unless Love INC specifically tells you otherwise, Love INC's role is to help make the connection. The person offering help is volunteering by their own choice, and Love INC does not direct or continuously supervise the work.

You understand that volunteer-assisted activities may involve ordinary risks to people and property. To the fullest extent permitted by law, you agree not to hold an individual volunteer or Love INC of Shelby County responsible for injury, property damage, loss, or other harm resulting from the ordinary negligence of a volunteer while providing the agreed-upon help. This does not apply to willful, wanton, reckless, or intentional misconduct, or to any responsibility that cannot legally be waived.

Love INC cannot guarantee that a volunteer will be available, that every requested task will be completed, or the outcome or quality of work voluntarily provided by another person.

Love INC may decline, postpone, change, or discontinue a volunteer connection when safety concerns arise or when a request is not appropriate for volunteer assistance.

You may withdraw your permission at any time by notifying Love INC by phone or email.
• You are not required to authorize sharing your information, but without it, Love INC may be limited in its ability to connect you with resources.
• You have the right to know what information has been shared and with whom, upon request.

TEXT APPROVAL
To help us serve you better, Love INC utilizes phone texting to keep you up to date on the status of your case and to communicate non-sensitive information to help coordinate services to meet your needs. Please complete the form below to allow Love INC to use text to help us serve you better.
This is not necessary, but would be helpful.