Butterfly Foundation
Butterfly Foundation Service Agreement: By agreeing below, I acknowledge that I am voluntarily requesting support services from the Butterfly Foundation, a program of Bright Futures Group Homes for Youth, Inc. I understand that: Services may include basic needs assistance, referrals, and help accessing social services. All information I provide will be kept confidential and used only to support my needs. Participation in services is voluntary and may be ended at any time by either party. I agree to treat staff, volunteers, and other participants with respect and to use the services provided responsibly.
Agreement
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I agree
I disagree (Your application can not move forward)
Name
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First Name
Last Name
E-mail
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example@example.com
Phone Number
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Services Needed:
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Basic necessities
Filling out forms
Other
Describe Your Problem
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File Upload (If Any)
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of
Urgency Level
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In the next 48 hours
This week
Not Urgent
How would you like to be contacted?
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Either phone or e-mail
By phone
By e-mail
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