Common Good Registration Form
Please fill out form completely. Any questions, contact Stefani at stefani@hisinc.org or 267-450-3220.
Organization Name
Name of Person Making Referral
First Name
Last Name
Phone Number of Person making referral
-
Area Code
Phone Number
Name of Individual coming to Common Good
First Name
Last Name
Phone Number for individual coming to Common Good
-
Area Code
Phone Number
Can the individual provide photo ID to verify identity?
Yes, drivers license
Yes, state issued ID
No, individual does not have ID
Other
Will anyone else be coming with the person listed above? If yes, please put their names below (please limit the number of children that come, and no more than 2 adults per appointment).
How much credit is the organization allowing the individual to use while at Common Good. (Please list max amount, or be specific about a particular number in the next question)
What is the individual looking to get while at Common Good? Please be as specific as possible, including clothing sizes.
Is there any additional information you would like to share with Common Good?
Schedule Your Appointment
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Network Partner Signature: I hereby agree that the above registrant is eligible to come to Common Good and that my organization is responsible for giving credit of the specified amount. I agree that I have explained the terms and conditions set forth by Hands in Service to who I am referring.
*
Referral Signature: I hereby agree that I will arrive on time to my scheduled appointment and that I understand the terms and conditions set forth by Hands in Service.
Submit
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