I read the above household eligibility qualifications, and I understand that Noah’s Miracles may request proof of income for all members of my household prior to providing assistance.

I authorize Noah’s Miracles or its agent to access any records (including financial records) required to verify my statements herein and to confirm my eligibility for Noah’s Miracles assistance programs. I authorize state or federal agency representatives to discuss with, and/or provide information to, Noah’s Miracles verifying my participation in public assistance Programs that qualify me for Noah’s Miracles assistance programs.

I release Noah’s Miracles, its board members and its employees from liability for any claims by me or any third party in connection with my participation.

I understand that an application does not guarantee when and/or if I will receive assistance. I understand Noah’s Miracles takes applications in chronological order as they are received.

Photograph and Publicity Release
I give Noah’s Miracles, permission to use my and my minor child’s name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of Noah’s Miracles. I agree that Noah’s Miracles have complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with Noah’s Miracles missions. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive any compensation, etc for the use of such pictures, etc., and hereby release Noah’s Miracles and its agents and assigns from any and all claims which arise out of or are in any way connected with such use.

I will email Noah’s Miracles if I DO NOT GIVE CONSENT to use my name and likeness to promote Noah’s Miracles program, and/or their activities.