Shelter Resident Participation Consent Form
Please complete this form to provide your consent for participation in shelter activities or programs.
Resident Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Resident Contact Number
*
Please enter a valid phone number.
Resident Email Address
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Please specify the activity or program you are consenting to participate in
*
Consent and Acknowledgement
*
Signature (please sign below to confirm your consent)
*
Submit Consent
Submit Consent
Should be Empty: