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Consent to Release of Information and Liability
As a client of Midtown Assistance Center (MAC), you may
receive one or more of the following services: grocery store gift cards,
grocery store delivery service, MARTA transportation assistance via pre-loaded
MARTA cards or similar means, and/or monetary assistance for rent payments or
utilities payments (Services). MAC uses
third party vendors to provide this assistance, and MAC is not an agent of or affiliated
with any of these companies in any way.
It may be necessary for MAC to provide a certain amount of your
information such as your name and address to a third party in providing you
with these services, including your landlord, employer or utilities companies.
By accepting these terms, you certify and agree to the following:
Limitation of Liability/Agreement not to sue: You agree
not to sue, bring a claim for damages, or hold MAC liable or responsible, in
any way, for any damages or harm that may arise out of your use of the Services. You further
agree not to hold MAC liable for release of your information to third parties
necessary to provide you with the Services. In no event will MAC be responsible
for or liable for any claims or damages arising in any way from any act or omission
or product of any third party vendor that MAC may utilize to provide the
Services to you.
In order to provide the Services, MAC may have been required
to agree to Terms and Conditions of third party vendors on your behalf. You
authorize MAC to agree to any such Terms and Conditions on your behalf, if
required by the third party vendors. You
agree and acknowledge that you may be bound by any Terms and Conditions entered
into on your behalf. You may request a copy of any Terms and Conditions that
MAC has entered into on your behalf in order to provide you the Services.
You consent to release of your information by MAC, including
to your landlord, utilities companies, your employer and vendors as necessary
to complete services, provide follow-up and statistics, or guard against
duplication of assistance.
You understand that by completing the forms as part of this
request, you are providing information and requesting assistance, and
completion of this request does not make you eligible for assistance. MAC will
evaluate all requests individually and notify you of whether you are eligible
for assistance. You certify that the information you have provided is true and
correct. You also understand that if the information you provide is not true
you will forfeit your ability to receive services from MAC.