1. Tell us about you.

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* 1. Contact information

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* 2. How did you hear about this?

We need a little more information to pair you up with a volunteer to help you fix your item. This takes about six minutes to fill out.
2. Tell us about the item that needs fixing

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* 3. What's your broken item?

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* 4. Please include an image of your item.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 5. Please include an image of the broken area. 

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 6. What's the brand name?

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* 7. What’s the model number? (look on the back or bottom)

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* 8. Describe the problem in detail, including information such as if the problem has been gradual or if there was an event that broke it, and if the  problem is constant or intermittent:

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* 9. Do you have any guesses about the underlying problem? What have you already attempted to do to fix it, if anything?

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* 10. Do you have access to tools (either your own or through borrowing or buying)? Your volunteer will discuss with you what you need.

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* 11. Additional image

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 12. Additional image

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 13. Additional image

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 14. Please review the statement below.

Please keep an eye on your email because you will be contacted for more details and to set up a repair session.

Thank you for participating in Hennepin County’s Fix-It Clinic Program (the “Program”). These services are provided free of charge. Because this Program uses volunteers, Hennepin County cannot guarantee the integrity, usability or effectiveness of the repairs undertaken at the Program. Neither Hennepin County nor its employees, agents or volunteers accept any liability for any damage or injury to person or property resulting from the use of item/s repaired.

In consideration of being allowed to participate in the Program at no cost to me, I hereby waive, release and forever discharge Hennepin County, its employees, agents and volunteers, and any others acting on their behalf, from any and all responsibilities or liability from damages or injuries of any kind to my property, anyone else's property, or to me or any other person, in my party or otherwise, as a result of my participation in this Program.
Thank you, we look forward to pairing you with a volunteer.

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