Rock the Block is limited to those in our targeted neighborhoods. We offer similiar repairs to other qualified homeowners in our service area (Madison and Clark Counties) through our A Brush with Kindness program as funding and volunteers allow. Click here to apply for a basic, outdoor repair through A Brush with Kindness. 

The above criteria are required in order to participate in Rock the Block. Participants should be prepared to provide documentation.

Homeowner Contact Information

Contact Information for Homeowner One

Contact Information for Homeowner Two

Contact Information for Homeowner Three

Household Information

Homeowner Demographic Information

Please read this statement before completing the box below: You are not required to provide this information. We will not take this information (or your decision to provide this information) into account in connection with your application. If you choose not to provide the information, we may note it by visual observation or surname.

Demographic Information for Homeowner One

Demographic Information for Homeowner Two

Demographic Information for Homeowner Three

Property Information

Insurance Information

NOTE:  Before work is done on your home, you must provide verifiable proof of homeowners insurance.

Personal Statement

Requested Repairs

Disclosures

Willingness to Partner

To be considered for this program, you must be willing to partner with HFHMCC. This includes participating in the assessment of repairs, meeting deadlines, providing a safe and hospitable work environment for staff and volunteers.

You must agree that all physically able persons in your household available at the scheduled date of services rendered will work alongside the Habitat for Humanity of Madison and Clark County volunteers and staff.

If you are not physically able to aide in the work performed on your home, or if the work on your home is not volunteer friendly, an alternate plan will be proposed.

The safety of staff and volunteers conducting home assessment and/or repairs is of the utmost importance to HFHMCC. If at any time the safety of staff or volunteers is at risk, they may leave the home immediately and not return to the home until the situation has been remediated.

Check the box and initial below to indicate if you accept this statement.

Homeowner Agreement

I certify that the information on this application is accurate and that I own the property at the given address.

I certify that verification may be obtained from any source named in this application.

I understand that this application can be rejected at any time if information provided is incorrect or untrue.

I further declare that I have no intention to move, sell, or rent this residence for at least three years.

I authorize Habitat for Humanity of Madison and Clark Counties to examine my income, residency, and any other requirements throughout the application
process.

Additionally, I certify that no members of our household are currently or will be involved in the future in any type of illegal activity and I authorize Habitat for Humanity of Madison and Clark Counties to investigate my criminal history if necessary.

I also understand that Habitat for Humanity screens all applicants and adults (18 years and up) in there household on the sex offender registry. By completing this application, I am submitting myself to such an inquiry.

As an applicant, I acknowledge Habitat for Humanity of Madison and Clark Counties has obtained non-public and public information for the application to be processed.

I understand that Habitat for Humanity will keep this information in a secure place and it will not be shared with any unauthorized parties.

I further understand that the people who may work on my house are unpaid volunteers and that few, if any of them, are skilled in the building trades.

I understand that Habitat’s Rock the Block Program makes no warranties, expressed or implied, regarding any materials used or work done by any of the volunteers throughout this
project.

I hereby agree that I will not make a claim against or sue Habitat for Humanity of Madison and Clark Counties and any of our affiliates for injury or damage resulting from negligence or other acts caused by any employee, contractor, or participant in the Rock the Block activities.

I hereby release Habitat for Humanity of Madison and Clark Counties and any of its affiliated organizations from all actions, claims or demands that I now have or may hereafter have for injury or damages resulting from my participation in the Rock the Block Project.