Participant Legal Agreement
Consent, Release, Waiver & Indemnification Agreement
Please read this entire agreement carefully before signing. This is a legally binding document required of every individual (a “Participant”) who receives housing navigation, referral coordination, transitional-housing support, or any other assistance from Hearth Housing, Inc. (“Hearth Housing”). It may also be signed by a parent, legal guardian, or authorized representative on behalf of a Participant. This agreement is governed by the laws of the State of Mississippi and, where applicable, by the laws of the Participant’s state of residence within the surrounding region (including Tennessee, Alabama, Arkansas, and Louisiana).
Read before signing. This document contains a release of legal claims, an assumption of risk, an indemnification obligation, a waiver of jury trial, and a binding arbitration and venue clause. By signing, you are giving up important legal rights, including the right to sue Hearth Housing in court for most claims. If you do not understand any part of this agreement, do not sign it until you have consulted with an attorney of your choice. This form is not itself legal advice.
1Voluntary Participation & Right to Withdraw
I understand that participation in any program, referral, or service offered by Hearth Housing is entirely voluntary. I may decline any service, stop participating, or withdraw my consent at any time by notifying Hearth Housing in writing at info@hearthhousing.com. Withdrawal does not release me from obligations that arose before the withdrawal (including the release, waiver, and indemnification provisions below), which survive termination.
2No Guarantee of Housing, Benefits, or Outcome
I understand that Hearth Housing provides housing navigation, information, coordination, and referrals — not housing itself. Hearth Housing does not own, lease, operate, inspect, license, or guarantee any housing unit, shelter bed, benefit, treatment slot, employment, transportation, or specific outcome. Waitlists, eligibility rules, background-check outcomes, and availability are controlled entirely by third-party providers and public agencies. No statement made by any staff member or volunteer creates a warranty, promise, or contract for housing.
3Independence of Third-Party Providers
I acknowledge that Hearth Housing may refer me to landlords, shelters, treatment providers, employers, government agencies, or other community partners. Those organizations are independent and set their own rules, decisions, and outcomes. Hearth Housing is not responsible for the acts, omissions, negligence, misconduct, condition of premises, safety, or availability of any third-party provider, and I release Hearth Housing from any claim arising out of my interaction with any such third party.
4Not a Crisis, Medical, Mental-Health, or Legal Service
Hearth Housing is not an emergency service, medical provider, mental-health provider, or law firm. I will not rely on Hearth Housing for emergency response, medical treatment, medication decisions, crisis intervention, or legal advice, and no communication with Hearth Housing creates a physician-patient, therapist-client, or attorney-client relationship. In an emergency I will call 911. For a mental-health crisis I will call or text 988(veterans press 1).
5Truthful Information & Background Information
I agree to provide accurate and complete information to the best of my knowledge. I understand that providing false, misleading, or fraudulent information may result in denial or termination of services and may be reported to relevant agencies as required by law. I authorize Hearth Housing to verify any information I provide with the sources reasonably necessary to coordinate services on my behalf.
6Code of Conduct
While participating in services or communicating with staff, volunteers, partners, or other participants, I agree to conduct myself respectfully. Hearth Housing has a zero-tolerance policy for violence, threats, harassment, discrimination, weapons on program premises, being under the influence in a way that endangers others, or damaging property. Violations may result in immediate suspension or termination of services and referrals, without refund or further obligation, and may be reported to law enforcement.
7Information Sharing & Privacy
I authorize Hearth Housing to share the information I provide with the partners, providers, and agencies reasonably necessary to coordinate housing and supportive services on my behalf. I understand Hearth Housing will make reasonable efforts to protect my information, but no system is perfectly secure. I will not submit Social Security numbers, full medical records, VA claim numbers, or other highly sensitive documents through this form.
8Photo, Video & Story Release (Optional)
I may separately grant permission below for Hearth Housing to use my likeness, story, first name, or general quotes in non-commercial materials such as its website, social media, newsletters, and grant reports. This permission is optional, is not required to receive services, and may be revoked in writing at any time (already-printed materials excepted).
9Assumption of Risk
I understand that seeking housing, transportation, treatment, employment, and community services involves inherent risks, including but not limited to exposure to unsafe premises, exposure to communicable disease, contact with other participants and members of the public, transportation hazards, and the unpredictability of third-party providers. I knowingly and voluntarily assume all such risks, whether known or unknown, foreseen or unforeseen, arising out of or related to my participation.
10Release & Waiver of Liability
To the fullest extent permitted by the laws of the State of Mississippi (and, where applicable, Tennessee, Alabama, Arkansas, or Louisiana), I, on behalf of myself, my heirs, executors, administrators, personal representatives, spouse, and assigns, hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Hearth Housing, Inc., its directors, officers, employees, staff, volunteers, agents, contractors, donors, and partner organizations (collectively, the “Released Parties”) from any and all claims, demands, damages, losses, costs, expenses, attorneys’ fees, or causes of action of any kind, whether in contract, tort, statute, or equity, arising out of or related in any way to my participation in Hearth Housing programs, referrals, or communications, including any claim based on the ordinary negligence of a Released Party. This release does not apply to claims arising from gross negligence, willful or wanton misconduct, or intentional acts, or to any right that cannot be waived under applicable law.
11Indemnification
To the fullest extent permitted by law, I agree to indemnify, defend, and hold harmlessthe Released Parties from and against any and all third-party claims, liabilities, damages, judgments, penalties, costs, and reasonable attorneys’ fees arising out of (a) my breach of this agreement, (b) my violation of the Code of Conduct, (c) my willful, reckless, or unlawful conduct, or (d) any misrepresentation of information I provided to Hearth Housing.
12Medical Authorization in an Emergency
If I am unable to consent for myself due to a medical emergency during any Hearth Housing activity, I authorize Hearth Housing staff and volunteers to summon emergency medical services and to share reasonably necessary information (including any emergency contact I have provided) with first responders and medical personnel. I understand that I, my insurer, or my responsible party remain financially responsible for any medical care I receive.
13Governing Law, Venue & Jury Waiver
This agreement shall be governed by and construed under the laws of the State of Mississippi, without regard to its conflict-of-laws principles. I agree that the exclusive venue for any action permitted to be brought in court (including any action to enforce arbitration or to seek injunctive relief) shall be the state or federal courts located in Hinds County, Mississippi, and I consent to the personal jurisdiction of those courts. TO THE FULLEST EXTENT PERMITTED BY LAW, I KNOWINGLY WAIVE ANY RIGHT TO A TRIAL BY JURY in any dispute arising out of or related to this agreement or my participation in Hearth Housing programs.
14Dispute Resolution: Notice, Mediation & Binding Arbitration
Step 1 — Notice. Before initiating any legal or arbitral proceeding, I agree to send written notice of the dispute to Hearth Housing at info@hearthhousing.com and to allow at least thirty (30) days for good-faith resolution.
Step 2 — Mediation. If the dispute is not resolved, the parties will attempt non-binding mediation with a neutral mediator located in Mississippi or Tennessee, with each party paying its own costs and splitting the mediator’s fee equally.
Step 3 — Binding Arbitration. Any remaining dispute shall be resolved by final and binding individual arbitration administered by the American Arbitration Association under its Consumer Arbitration Rules, seated in Jackson, Mississippi (or, by mutual agreement, Memphis, Tennessee). Judgment on the award may be entered in any court of competent jurisdiction. I waive the right to participate in any class, collective, or representative action against Hearth Housing. Nothing in this section prevents either party from seeking emergency injunctive relief in the courts identified in Section 13.
15Compliance with Federal & State Non-Discrimination Law
Hearth Housing complies with the federal Fair Housing Act, the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and applicable state civil-rights laws in Mississippi, Tennessee, and surrounding states. Nothing in this agreement waives any right the Participant has under those laws, and any provision that would do so is severable and unenforceable to that extent only.
16Termination of Services
I understand Hearth Housing may modify, pause, or end services at any time, including for safety reasons, code-of-conduct violations, loss of funding, or a determination that services are no longer the right fit. Whenever possible, Hearth Housing will provide alternate referrals.
17Severability, Entire Agreement & Electronic Signature
If any provision of this agreement is held unenforceable by a court or arbitrator, the remaining provisions shall remain in full force and effect, and the unenforceable provision shall be modified to the minimum extent necessary to be enforceable. This document, together with any program-specific forms I sign, constitutes the entire agreement between me and Hearth Housing regarding this subject matter and supersedes any prior oral statements. I agree, under the federal E-SIGN Act and the Mississippi and Tennessee Uniform Electronic Transactions Acts, that my typed signature below has the same legal effect as a handwritten signature.
18Acknowledgment
I have read (or had read to me) all sections above, including the release, indemnification, jury waiver, and arbitration provisions. I have had an opportunity to ask questions and, if I wished, to consult an attorney. I sign this agreement freely, voluntarily, and with full understanding of its legal effect.