FRIENDS AND FAMILY RESOURCE HUB

  • FRIENDS AND FAMILY RESOURCE HUB

  • CLIENT SERVICE AGREEMENT & CONSENT FORM

  • Organization Name: Friends and Family Resource Hub
  • Purpose: Community Support & Resource Assistance

  • OUR PURPOSE OF SERVICES

  • Friends and Family Resource Hub is a nonprofit organization dedicated to assisting individuals and families within the community by providing guidance and support with accessing public benefits and services, including but not limited to:
    • SNAP (Supplemental Nutrition Assistance Program)
    • Cash Assistance
    • Medicaid
    • Employment and Training Programs
    • Family Court Advocacy Support
    • Housing Assistance (including CityFHEPS/FHEPS and other housing applications)
  • We aim to provide support, information, and assistance throughout the application and referral process.

  • VOLUNTARY PARTICIPATION

  • By signing this agreement, you acknowledge that:
    • Your participation with Friends and Family Resource Hub is completely voluntary.
  • - You may choose to stop receiving services at any time.

  • 3. CLIENT CONSENT FOR INFORMATION

  • By signing below, you agree that:
  • - All the information you provide is given voluntarily and with your full consent.
  • - You authorize Friends and Family Resource Hub to use your information only for the purpose of assisting you with applications, services, and referrals.
  • - You confirm that the information you provide is true and accurate to the best of your knowledge.

  • 4. CONFIDENTIALITY

  • Friends and Family Resource Hub are committed to protecting your privacy.
  • - All personal information shared will be kept strictly confidential.
  • - Your information will not be shared with third parties without your permission, except when required to process applications or as required by law.
  • - We take reasonable steps to safeguard your information.

  • 5. NO GUARANTEE OF BENEFITS

  • - Friends and Family Resource Hub does not guarantee approval for any benefits or services.
  • - Final decisions are made by the respective agencies (e.g., government programs, housing authorities, courts).

  • 6. NO FEES / DONATION POLICY

  • - Friends and Family Resource Hub provides services free of charge.
  • - We do not require or accept payment for services.
  • - Voluntary donations are accepted to support our mission, but they are not required and do not
    influence the services provided.

  • 7. LIMITATION OF LIABILITY

  • - Friends and Family Resource Hub provides assistance and guidance but is not responsible for
    decisions made by external agencies.
    - We are not liable for delays, denials, or outcomes related to applications or services.

  • 8. CLIENT ACKNOWLEDGMENT

  • By signing below, you confirm that:
    - You have read and understand this agreement.
    - You consent to receive services from Friends and Family Resource Hub.
    - You agree with the terms
    outlined above.

  • CLIENT INFORMATION

  • Format: (000) 000-0000.
  • Date:
     - -

  • ORGANIZATION REPRESENTATIVE

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