Hays Paint-A-Thon is a program that helps low-income seniors and people with permanent physical disabilities continue to live independently in their own homes. A volunteer team is matched to scrape, prime and paint the exterior of each eligible home/garage, thereby keeping it well-maintained, beautiful and an asset to the neighborhood. All of this is done at no cost to the homeowner. Hays Paint-A-Thon is a project of the Hays Rotary Club.
Eligible homeowners must:
■ Be over the age of 60 or have a permanent physical disability.
■ Own and occupy a single-family home in Hays that needs the exterior painted, but does not need major
repairs.
■ Live in a home where the monthly income of all persons living there does not exceed the following
guidelines:
2013 Application Timeline
August 1: Application deadline.
August 2 – 20: Paint-A-Thon home inspector visits and evaluates the home of each applicant.
August 21 – 25: All applicants will be notified if they have been chosen for the 2011 Paint-A-Thon.
August 21 – 30: Paint colors selected. (You may choose one of 10 colors of paint. We cannot provide stain.
If your home is selected
August 21 – 30: Hays Noon Rotary representative contacts homeowner to select paint colors and make
painting arrangements.
Saturday, September 7: House prep work
September 14 or 28: Paint-A-Thon Weekend (when most homes are painted) September 28 or October 5: Rain/Excessive Heat or Wind Date

Homes are selected based on financial need, the condition of the home and suitability for volunteer workers. Not every application will be approved. If the reason for declining the application is because we do not have
Household Size
1
2
3
4
5
Monthly Income
$1,800
$2,500
$3,100
$3,700
$4,300

enough volunteer teams to paint each eligible home, we will consider that application for the 2014 Paint-A-Thon.
Please note: Hays Paint-A-Thon does not paint home interiors, duplexes, rental properties or homes the owner no longer occupies, nor do we prepare homes to go up for sale.
For more information, contact: Greg Sund, at (785) 259-0622 or
[email protected]
2013 Paint-A-Thon Application
Homeowner Name: __________________________________________________ Date of Birth: ______________ Spouse (if applicable): ________________________________________________ Date of Birth: ______________ Street Address: ____________________________________________________________________________ City: ___________________________ State: _________ Zip: ______________
Home Phone: _________________________________ Other Phone: ___________________________________
Eligibility
Those aged 60 and older are eligible. Individuals younger than 60 with a permanent, physical disability are also eligible and must attach a physician’s statement defining the disability. Applications will not be processed if the applicant does not check one of the statements below.
___ I am 60 or older.
___ I am younger than 60, but have a permanent physical disability and my physician’s statement is enclosed. Household
Number of children/dependents living with you: ____________ Number of renters/roommates: ___________
If there are other adults living in the home besides you, are they able to help paint? ___ Yes ___ No
If no, please explain: __________________________________________________________________________
Total Monthly Income: $___________________ (Includes public assistance, pensions, annuities, rental income, salaries and social security income received by all household members. Verification of your income may be requested.)
Emergency Contact (Required) – Please list a local relative, neighbor or friend.
Name: _________________________________ Relationship: ___________________ Phone: ______________ Your Home
Which of the following descriptions best describes your house (Circle One):
Mobile Home One story 1 1⁄2 Story 2 story 2 1⁄2 story
Garage: Yes No
What year was your home built (approximate year is okay)? _____
When was your home and garage last painted? House: _____ Garage: ______ (enter N/A if there is no garage) It is very important that the volunteers have access to a bathroom. Would yours be available? ___ Yes ___ No Areas that need painting: (Mark all that apply)
___House Siding ___House Trim ___Garage Siding ___ Garage Trim ___Other: ______________________
Siding Type:
House: ___Wood ___Brick ___Shakes ___Stucco ___Painted Stucco ___Asbestos/Slate ___Aluminum ___Vinyl
Garage: ___Wood ___Brick ___Shakes ___Stucco __Painted Stucco ___Asbestos/Slate ___Aluminum ___Vinyl
Trim Type:
House: ___Wood ___Vinyl ___Metal Garage: ___Wood ___Vinyl ___Metal
_____________________________________________________________________________________________
Certification and Signatures
I certify that the information in this application is true to the best of my knowledge and belief. I also certify that I do not plan or intend to sell my home within the next two years. I am aware that I will be charged for the cost of the paint and the time should the house be sold within two years from the date painted, unless it is determined that there are extenuating circumstances. I confirm that any physically able person(s) residing in my home or visiting for the project day will work alongside Paint-A-Thon volunteers. I also confirm that, except for conditions that may be described in this application, my home and the surrounding area is a safe place for volunteers.
I understand that my home may be tested for the presence of lead-based paint by the Paint-A-Thon home inspector. I understand that if my home is selected, photographs may be taken of me and/or my home, and these photographs may be used by the news media and/or in publications and materials to help promote Hays Paint-A-Thon and/or the Hays Rotary Club. I understand that the people who may work on my home are unpaid volunteers; that few (if any) of these volunteers are skilled in the building trades; and that Hays Paint-A-Thon and the Hays Noon Rotary Club make no warranties or representation, express or implied, about any of the material(s) used or work done by anyone on my house. I hereby release Hays Paint-A-Thon and the Hays, Kansas Noon Rotary Club, and all associated with it, from all liability arising from negligence for any personal injury or property damage arising out of or relating to the work done on my house. I further certify that I have, and will maintain, homeowner’s insurance.
Homeowner #1 Signature: ____________________________________________ Date: ____________________
Homeowner #2 Signature, if applicable: _________________________________ Date: ____________________
Please complete if you are a non-homeowner assisting the homeowner in completing this application:
Name (Please Print): ____________________________________________________________________________________________
Relationship: ______________________________________ Daytime Phone: ____________________________
Return completed application by August 1 to: Hays Paint-A-Thon, PO Box 1186, Hays, KS 67601 Hays Paint-A-Thon is a project of the Hays Noon Rotary Club.