The Emergency Basic Needs Assistance Program, provided by Healthy Mothers Healthy Babies Coalition of Broward County, Inc. has been explained to me.
By signing below I understand and agree to the terms of the Emergency Basic Needs Assistance Program. I give permission to release all information obtained by the Emergency Basic Needs Assistance Program staff to funders or other providers for the purpose of case management, referrals, and linkages to other services.
I authorize staff to contact any other parties which may be necessary to assist with the provision of financial assistance.