First Baptist Church of Sutherland Springs
Assistance Policy
Effective April 1, 2018
The assistance request form may be utilized for requests related to supporting the victims or families affected
by the November 5, 2017 shooting incident.
Restoration Committee (Victim Assistance) Guidelines:
1. The Restoration Committee is responsible for administering programs related to Victim Assistance
resulting from the November 5, 2017 shooting incident. Requests are limited to the assistance of
victims or family members of victims. Payment will be made from funds received and designated for
victim relief. If the funds are exhausted, standard benevolence guidelines will apply.
2. Assistance requests may be made for a wide variety of reasons, such as medical equipment, medical
supplies, legal fees, housing modifications (to assist with mobility impared family members),
rent/mortgage, utilities, transportation or other expenses .
3. Multiple applications may be received in a calendar year.
4. Payment of expenses may be made directly the provider or may be made to the applicant for
distribution to providers. Payment will typically be made by check. Evidence of the amount required to
meet needs such as copies of bills, prescriptions for medications, etc. must be provided.
5. If approved, applications for recurring items such as rent/mortgage, utility bills, medicines will be valid
for a 3 month period.
6. Applications will be reviewed by members of the Restoration Committee and must be approved by at
least two members of the Committee.
7. Applications and information they contain will be held in strict confidence by all parties.
Hold Harmless / Liability Release
First Baptist Church of Sutherland Springs, Texas, its Pastor, Officers, Agents, Employees and Members are
hereby released, forever discharged and held harmless from any and all liability, claims or demands for
personal injury, sickness or death, as well as property damage and expenses of any nature whatsoever which
may be incurred as a result of the review, approval, payment and/or denial of benefits under the
administration of the Benevolence or Victim Assistance programs. Furthermore, the requestor hereby agrees
to hold harmless and indemnify said Church, its Pastor, Officers, Agents, Employees and Members from any
financial liability sustained by said acts of the aforementioned church parties.

 First Baptist Church of Sutherland Springs
Victim Assistance Request
Name of Applicant
Application Date
Current Address

Mailing Address,
(if different)
Phone Number
Email Address
Household Members

Relationship

Type of Assistance Requested

Age

Employment Status

Amount Requested

For How Long?

Please List Other Sources of Assistance Received in Past 6 months

Approx Amount Received

I have read and understand the policies and guidelines for assistance receipt from the First Baptist Church of Sutherland Spings. My
signature constitutes my understanding and agreement to abide by them.

Applicant Signature

Reviewed By

Date

Approved?

Reviewed By

Yes

No