Name
*
First Name
Last Name
Email
Phone
*
(###)
###
####
What Category is the Need?
Is This Request Urgent?
*
Only mark this section if the childs birthday is within 2 weeks, or if it is an emergency request. If you mark this section and your need was found to be non-urgent, it may result in the denial of any assistance.
Anything Else We Should Know?
Disclaimers & Liability Release
*
**MUST READ ALL**
Disclaimer & Release of Liability
By submitting this form, you acknowledge and agree to the following:
1. No Guarantee of Assistance
Submission of this request form does not guarantee that you or your family will receive any financial or material assistance from the Sarah Mae Foundation.
If assistance is provided, the type, amount, and duration of such assistance are at the sole discretion of the Sarah Mae Foundation and are strictly subject to available funds.
2. Media Consent & Publicity Release
By checking the box below, you grant the Sarah Mae Foundation full and unrestricted rights to photograph, video record, and otherwise document the assistance provided.
This includes consent for media of adults and minors present during assistance.
The Sarah Mae Foundation retains the right to use such media, without compensation, for fundraising, marketing, publicity, and social media purposes.
3. Release of Liability
By checking the box below, you agree to release and hold harmless the Sarah Mae Foundation, its board, staff, and volunteers from any and all legal claims, liabilities, or damages related to:
The provision, reduction, or denial of assistance,
The use of photos, videos, or other media,
Any outcomes resulting directly or indirectly from assistance provided or not provided.
4. Acknowledgment of Terms
You understand that the Sarah Mae Foundation is a fund-driven nonprofit organization, and its ability to provide support is limited and varies over time.
You agree not to pursue legal action against the Sarah Mae Foundation for any reason connected to this request or assistance process.
By checking the acknowledgment box on this form, you confirm that you have read, understood, and agreed to this disclaimer and release.
Applicant Acknowledgement
*
By checking the box below, you acknowledge and agree to the following:
Donation-Based Program
The Sarah Mae Foundation is a community project funded entirely through donations. Assistance is limited and provided only when funding is available.
Intended Purpose
Assistance is intended for families and individuals who are genuinely struggling or facing hardship due to unforeseen emergencies. It is not intended to replace personal financial responsibility, including the care of children or household needs.
Application Review
All applications are subject to review, which may include consideration of background information and public social media accounts to help determine eligibility.
Good Faith Requirement
You agree to submit requests in good faith. Submitting a request when you do not truly need assistance wastes resources and limits our ability to serve families in genuine need.
By checking the box, you confirm that you understand these terms and agree to apply honestly and responsibly.
Thank you! Your request for assitance is being reviewed. Please expect and answer any incoming text, phone calls or emails in the following days. You will be notified if the request is denied or if we do not have the resources currently available.
