Voucher Shopping Appointment Request Form

Clothing Voucher Referral & Appointment Request Form

NOT FOR CLIENT USE.
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?*
What are you clients names (first and last) and ages?*
Client's Contact Number:
Please enter a valid phone number.
Is the placement:*
If your client would like to opt-in to our Foster Parent Newsletter, please enter their email address below.
Client's Email Address:
example@example.com
How many children are you referring?*
How many adults are you referring?*
Where are they located?*
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 60 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

Boutique Voucher Shopping Policy:

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