I, Full Name of Self/Parent/Guardian*      have read and understand the Embracing Abilities policies as laid out in the document above. I agree to adhere to these policies in regards to the services being provided for   Client Name*.  I have been provided with a downloadable copy of these policies. I agree to the following policies that are detailed in this packet: Medical Emergency Consent, Authorization of use of E-mail and Facsimile for transmission of Personal Health information, Electronic Storage of Records, Use of texting, Home Attendance Pest policy, Attendance policy, PAC/RSPO/RHS Usage of Hours, PAC/RSPO/RHS - Staff Scheduling, Consumer Grievance policy, Medication Release, and Change in Diagnosis & Medications policy.
   Signature*   Date*