Free Oil Change Application

First Name*

Last Name*

Email Address

Phone Number*

Address*

City*

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TN County*

VIN Number*

Vehicle Year*

Vehicle Make*

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Vehicle Mileage*

How did you learn about getting a free oil change?*

Message

It is an honor to provide local Single Moms and Widows in our community with a complimentary oil change with routine vehicle maintenance. We want you to know that you are loved and are not alone! Every week several of those with appointments fail to show up and do not let us know they can no longer keep their appointment thus preventing us from giving it to someone else and leaving up to 15 volunteers with nothing to do. In order for Round Lick to continue providing this ministry, please read and consent to the following statement. We want to continue blessing people with this ministry but we also want to respect the volunteers who give their time to make it possible. It is an honor to provide local Single Moms and Widows in our community with a complimentary oil change with routine vehicle maintenance. We want you to know that you are loved and are not alone! Every week several of those with appointments fail to show up and do not let us know they can no longer keep their appointment thus preventing us from giving it to someone else and leaving up to 15 volunteers with nothing to do. In order for Round Lick to continue providing this ministry, please read and consent to the following statement. We want to continue blessing people with this ministry but we also want to respect the volunteers who give their time to make it possible. I have read the above statement and agree to keep my appointment time or to notify the ministry team as soon as possible if circumstance prevent me from keeping it.*

Proof of registration may be required for service Proof of registration may be required for service I affirm that this vehicle is registered in my name or that I have permission to have it serviced*

I have read and understand the Recipient Release and Waiver of Liability I have read and understand the Recipient Release and Waiver of Liability I agree*