Voucher Shopping Appointment Request Form

Clothing Voucher Referral & Appointment Request Form

NOT FOR CLIENT USE.
The Beacon Hill Boutique is currently closed due to renovations, re-opening TBA

If a family is experiencing a crisis, please call our Safe Families Hotline at (907) 277-0925 -OR- download the 907 Navigation App or visit www.alaskaimpactalliance.com/907-resource-navigations/ to access other resources available in our community.

For further questions, email boutique@beaconhillak.com
All government and private social service organizations, congregations, schools, and Beacon Hill staff are eligible to refer a family for voucher assistance.

All referrals and appointment requests must be made by eligible individuals.
Referring Agents Full Name*

First NameLast Name
Referring Agents Contact Number:*
Please enter a valid phone number.
Referring Agents Email Address:*
example@example.com
What agency are you with?*
How many children are you referring?*
How many adults are you referring?*
Client Info:
Please list ALL client(s) FIRST + LAST NAMES & D.O.B. (Including children)*
What is the nature of the placement?*
Where are they located?*
Client Contact Number:*
Please enter a valid phone number.
Is there any other important information we may need to know?
Please select an appointment time*
Boutique Voucher Shopping Policy:
Please ensure that you and your client(s) both read, understand and agree to the below policy.
Punctuality:

All appointments are for a duration of 120 minutes and require a punctual arrival and departure.

If a client arrives late, 15 minutes or more, their appointment will be cancelled. The client(s) referring agent may reschedule their appointment at their discretion.

If tardiness becomes a repeated offense, (3 incidents or more), their voucher(s) will become void for a period of 6 months before rescheduling can be explored.

All appointments must be made 24 hours in advance.

All cancellations or rescheduling must take place 24 hours before your appointment is scheduled.

No-Call No-Show's:

If a client does not attend their appointment without first informing staff, it will be considered a No-Call No-Show.

If no-call-no-shows become a repeated offense, (3 incidents or more), their voucher(s) will become void for a period of 6 months before rescheduling can be explored.
Should be Empty:

Clothing Voucher Referral & Appointment Request Form

Client Info:

Boutique Voucher Shopping Policy:

Please ensure that you and your client(s) both read, understand and agree to the below policy.