If you have any questions regarding this form, please contact your CCHS Social Services Worker. This consent shall expire in (1) calendar year. You may revoke consent at any time by contacting your Social Services Worker.
Rights of Persons with Developmental Disabilities
I give Columbus Center for Human Services, Inc. permission to:
*APSI is the guardian of person ONLY and has no legal right to assume financial responsibility.
Explanation of Payee Services
*Please note: CCHS, Inc. utilizes cameras on its grounds for environmental security
Open Door Art Studio & Gallery Consignment and Sales Agreement