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First Time Homebuyers

Congratulations on your first step toward homeownership! Our program is designed to guide you from

start; education, to the finish; closing on your new home. Please take note of some important

information you need before attending the First Time Homebuyers Education Workshop. The classes are from 5:30-9:30PM on the third Wednesday and Thursday of the month. You must arrive on time and stay for the full time to receive a certificate of completion

You are required to bring a valid governmental issued Photo identification and your most current paystub to the workshop on the first night. These documents are required in order to receive a certificate of completion.

After you have successfully completed the eight hour workshop, you will be awarded The Urban League Palm Beach County Certificate of Completion. A housing representative will contact you within 30 days thereafter to schedule your one-on-one counseling session with an Urban League Palm Beach County Certified Housing Counselor.

At the one-on-one counseling session you will be provided guidance and given an action plan to put you on track toward achieving The American Dream, Buying Your Own Home.

At the First Time Homebuyer’s Workshop a checklist will be given to you. Please be aware that you must bring the required documents to your One-on-One counseling appointment. Failure to do so will cause your appointment to be rescheduled. Your cooperation is imperative to ensure a smooth process. Thank you for trusting The Urban League of Palm Beach County to assist you in your road to Homeownership Success.

Once Again Congratulations

Urban League of Palm Beach County, Inc.

Housing Department

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Please fully complete the attached Intake Forms and,

bring all pertinent documents below to scheduled appointment

First Time Homebuyer Checklist

Please fully complete the attached Intake Forms and Bring all pertinent documents below to scheduled appointment

_____ Driver's License and/or government issued photo ID (All adults 18 years or over in Households) _____ Notarized Affidavit of Proper Address (If address does not match the Driver's License)

_____ Social Security Cards for all household members _____ Copy of Alien ID Cards (If applicable)

_____ Children's Birth Certificates _____ Copy of all Utility Bills

_____ Most recent 30 consecutive days pay stubs for all working adults (18 years & older) & Other applicable income such as: Benefits Statements for Social Security, AFDC, TANF Food Stamps, Retirements, SSI, Proof of Child Support or Child Support Order, Unemployment or Worker’s Compensation.

_____ Two (2) most recent consecutive Bank Statements (All pages)

_____ Two (2) years most recent signed Tax Return with W2 Tax Forms (All pages and schedules) _____ Self-employed: Two (2) years Tax Returns signed with all schedules and Profit & Loss Financial Statements

_____ Most recent other assets such as: IRA’s, Stocks, Bonds, etc.

_____ Credit Report (ULPBC will obtain for an $18.00 per person Credit Report Fee) Please bring Cash or Money Order to your appointment _____ Pre-approval from Lender (If applicable)

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HOMEBUYER INTAKE APPLICATION

Client ID#: ________________________

APPLICANT

PLEASE PRINT CLEARLY

Name: ___________________________________ _______ _____________________________________

First MI Last

Address: ______________________________________ ___________________ _____ ____________

Street City State Zip

Home: (________) __________-______________ Work: (_________)___________-_____________ Cell: (________) __________-______________ Email: ___________________________________

_________- _____ - _________ ________ - _____ - _______

Social Security Number Date of Birth

Race (Please circle):

(1) American Indian/Alaskan Native & White (2) Black or African American (3) American Indian/Alaskan Native (4) American Indian/Alaskan Native & Black (5) White (6) Asian (7) Asian & White

(8) Native Hawaiian/Other Pacific Islander (9) Black/African American & White (10) Other: ______________________ Ethnicity (Please select “Yes” or “No” for Hispanic Origin): English Proficiency:

Hispanic: Yes No Is English Proficient Is Not English Proficient Marital Status (Please circle): (1) Single (2) Married (3) Divorced (4) Separated (5) Widowed

Gender (Please circle): Male Female Disabled (Please circle)? Yes No Current Housing Arrangement (Please select one):

(1) Rent (2) Homeless (3) Homeowner with mortgage (4) Living with family member and not paying rent (5) Homeowner with mortgage paid off

Rural Status?

Does Not Live In Rural Area Lives In Rural Area Chose Not To Respond

(1) Female headed single parent household (2) Two or more unrelated adults (3) Single Adult

(4) Male headed single parent household (6) Married without children (5) Married with children (7) Other

Family/Household Size: ________ How many dependents? ________

What ages are they? _______,_______,_______,_______,_______,________,________,________,________, Are there non-dependents who will be living in the home? Yes ______ No _______ (if yes list below) _____________________________ _____ _____________________________ _____

Relationship Age Relationship Age

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Education (Please circle one):

(1) High School Diploma or Equivalent - (2) Two-Year Degree - (3) Bachelor’s Degree - (4) Master’s Degree

Referred to by (please select all that apply)

UL Employee/Board Member Bank Walk-In TV Realtor Government Agency Advertisement Friend Radio Newspaper

If you were referred by a bank, which one? _________________________________________

CO-APPLICANT

PLEASE PRINT CLEARLY

Name: ___________________________________ _______ _____________________________________

First MI Last

Address: ______________________________________ ___________________ _____ ____________

Street City State Zip

Home: (________) __________-______________ Work: (_________)___________-_____________

Cell: (_________) ___________- _____________ Email: ___________________________________________ ___________- _________ - _____________ ___________ - __________ - _________

Social Security Number Date of Birth

Race (Please circle):

(1) American Indian/Alaskan Native & White (2) Black or African American (3) American Indian/Alaskan Native (4) American Indian/Alaskan Native & Black (5) White (6) Asian (7) Asian & White

(8) Native Hawaiian/Other Pacific Islander (9) Black/African American & White (10) Other: _____________ Ethnicity (Please select “Yes” or “No” for Hispanic Origin): English Proficiency:

Hispanic: Yes No Is English Proficient Is Not English Proficient Marital Status (Please circle) (1) Single (2) Married (3) Divorced (4) Separated (5) Widowed Gender (Please circle): Male Female Disabled (please circle)? Yes No

Education (Please circle one):

(1)High School Diploma or Equivalent (2) Some College (3) Bachelor’s Degree (4) Master’s Degree (5) No High School (6) Some High School

Relationship to Applicant (Please circle one):

Spouse Daughter Son Sister Brother Girlfriend Boyfriend Mother Father Other (please specify) _______________________________

Active Military: No Yes N/A Veteran? Foreign Born? Housing Choice Voucher?

APPLICANT EMPLOYMENT

PLEASE PRINT CLEARLY

Primary Employer: ____________________________________________________________________________________ ___________________________________________ ________________________________

Position / Title Hire Date

____________________________________________________________________________________________________

Street City State Zip

Phone: (_____)_______-________________ Part-Time or Full-Time (Please Circle)

Gross Income (before Taxes): $ _________________________________________

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Secondary Employment: __________________________________________________________________

__________________________________________ ________________________________

Position / Title Hire Date

___________________________________ __________________________ ______ __________

Address City State Zip

Phone: (_____) _______-________________

Part-Time Full-Time (Please Circle)

Gross Income (before Taxes): $ _________________________________________

Paid Weekly Bi-weekly Twice a Month Monthly

CO-APPLICANT EMPLOYMENT

PLEASE PRINT CLEARLY

Primary Employer: ____________________________________________________________________________________ ___________________________________________ ________________________________

Position / Title Hire Date

___________________________________ __________________________ ______ __________

Address City State Zip

Phone: (_____)_______-________________ Part-Time or Full-Time (Please Circle)

Gross Income (before Taxes): $ _________________________________________

Paid Weekly Bi-weekly Twice a Month Monthly

Secondary Employment: _____________________________________________________________________

__________________________________________ ________________________________

Position / Title Hire Date

___________________________________ __________________________ ______ __________

Address City State Zip

Phone: (_____)_______-________________ Part-Time or Full-Time (Please Circle)

Gross Income (before Taxes): $ _________________________________________

Paid Weekly Bi-weekly Twice a Month Monthly

INCOME

PLEASE PRINT CLEARLY

Type of Income Customer Monthly Amount Co-Applicant Monthly

Amount

Salary

Alimony/Child Support

*Current Rent or Mortgage Payment

Rental Income Social Security Pension Income Public Assistance

Self-Employment Income Dependent SSI Income Disability Income Other Income

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Circle One

APPLICANT CO-APPLICANT

Can you document your child support/alimony Income? Yes No N/A Yes No N/A

If yes, how long will it continue? ____ ____ ___ ___ If your child or family member receives SSI, Yes No N/A Yes No N/A

How many more years will the payment continue? ____ ____ ___ ___ If you receive disability income, Is it for permanent disability Yes No N/A Yes No N/A

____ ____ ___ ___

Regarding other employment, have you worked in this field

for two or more years? Yes No N/A Yes No N/A

____ ____ ___ ___ Are you currently in Chapter 13 Bankruptcy? Yes No N/A Yes No N/A

If yes, when did it begin? ____ ____ ___ ___ If yes, when will it be paid in full? ____ ____ ___ ___ If yes, how much is the payment? ____ ____ ___ ___ Have your payments been made on time? Yes No N/A Yes No N/A

____ ____ ____ ____ Have you ever filed a Chapter 7 Bankruptcy? Yes No N/A Yes No N/A

If yes, when was it discharged? ____ ____ ____ ____

LIQUID FUNDS/SAVINGS/INVESTMENTS

PLEASE PRINT CLEARLY

Please list the appropriate value of the following

:

APPLICANT CO-APPLICANT Checking Account Savings Account Cash CDs

Securities (stocks, bonds, etc.) Retirement Account

Are you about to receive additional funds (e.g., tax refunds, property sales, etc.)? Yes No

If yes, how much? $ _____________

ADDITIONAL INFORMATION

PLEASE PRINT CLEARLY

APPLICANT CO-APPLICANT

Have you owned a home in the last Three (3) years? Yes No Yes No

Are you a Veteran? Yes No Yes No

Do you have a contract on a home at this time? Yes No Yes No

Are you currently working with a real-estate agent? Yes No Yes No

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ALTERNATIVE DELIVERY OF SERVICES FOR IMPAIRED AND DISABLED INDIVIDUALS

Urban League of Palm Beach County is sensitive to the special needs of all of our clients. If you have an

impairment, disability, and/or language difficulty and need access to our services, please contact us so we may assist you accordingly.

AUTHORIZATION

PLEASE READ THE FOLLOWING BEFORE SIGNING

I authorize the Urban League of Palm Beach County (a HUD certified Housing Counseling Agency) to: (a) Charge a credit report fee of $18. This will allow Urban League of Palm Beach County the ability to pull my/our credit report to review my/our credit file for housing counseling in connection with my pursuit on a loan to purchase real property (a new Home); Borrower Initial ___, Co-borrower initial ___ (b) Obtain a copy of the HUD-1 Settlement Statement, Appraisal, and Real Estate Note(s) when I

purchase a home, from the lender who made me/us a loan and/ or the title company that closed the loan. Borrower Initial ___, Co-borrower initial ___.

By signing this application, I certify that the information given to the Urban League of Palm Beach County, Comprehensive Housing Counseling program of household composition income, net family assets and all allowances and deductions are accurate and complete to the best of my knowledge or belief. The information solicited on this application by the Urban League of Palm Beach County in order to assure that Federal Laws prohibiting discrimination against tenants and applicants on the basis of race, color, national origin, religion, sex, family status, age, and handicap are complied with. You are not required to furnish this information, but are encouraged to do so. This information will not be used to discriminate against you in any way.

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Client Authorization for Counseling Agency

I/We authorize the Urban League of Palm Beach County, Inc. to discuss with me/us any information related to my/our personal circumstances as may be necessary to help me/us to solve my/our housing problems. I/We further authorize the Urban League of Palm Beach County, Inc. to release to other firms, funders and other third parties agencies information related to our file. I/We understand that the information about our personal circumstances will be treated totally confidential and no information about me/us will be accessible to any party who is not directly involved in my/our situation.

_________________________________________ ___________________________________

Signature of Head of Household Date

_________________________________________ ___________________________________

Signature of Spouse Date

ACKNOWLEDGEMENT OF COUNSELING PLAN

I, ______________________________, accept and agree to comply with the counseling Action Plan implemented to assist me in the resolution of my housing problem or meeting my housing need. Failure to comply with the counseling Action Plan could result in termination of counseling. Termination may occur under any of these conditions:

1. Failure to submit requested documentation no more than 10 working days after initial appointment.

2. Failure to appear at counseling appointment.

3. Failure to follow the agreed upon counseling Action Plan.

4. Failure to respond to phone calls or correspondence received by the Urban League. _________________________________________ _________________________________

Signature Date

DATA BECOMES THE PROPERTY OF THE URBAN LEAGUE OF PBC, INC.

ALL documents copied during the screening process by the Housing Counselor to identify the housing need or problem shall become the property of the Urban League of Palm Beach County, Inc. Such documents shall include but not be limited to the following: pay stubs, bank statements, tax returns and W2’s, correspondence, social security cards, driver’s license, property tax statements, warranty deed, financial documentation, social security documentation, etc. I/We authorize the agency to open my/our client file to be reviewed for program monitoring and compliance purposes. I/We also authorize the agency to conduct necessary activities related to these services.

_________________________________________ ___________________________________

Signature Date

_________________________________________ ___________________________________

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Conflict of Interest Policy Statement

The Urban League of Palm Beach County provides the following housing counseling services: Pre/Post purchase counseling, foreclosure mitigation and default counseling, rental assistance, home buyer education and financial literacy education.

I/We understand that it is my/our right and responsibility to decide whether to engage in any course of housing counseling with the Urban League of Palm Beach County and determine whether counseling is suitable for my/our housing issue.

I/We understand that the Urban League of Palm Beach County has the discretion to charge reasonable fees for some counseling services, and that these fees will be explained to me prior to any counseling. I further understand that fees will not be charged if they create a financial hardship and that I will not be denied counseling if I cannot pay the fees.

I/We understand that the Urban League of Palm Beach County provides information on a broad range of housing programs and products, and that the Urban League of Palm Beach County provides rental housing through its affiliate, New Urban Community Development Corporation. The Urban League of Palm Beach County partners with banks and mortgage providers, fair housing agencies, legal service providers, insurance providers, foundations, title companies, real estate agents and/or brokerages, and credit counseling service providers. I understand that I am not obligated to choose any particular loan product or housing program discussed in my counseling sessions. I/We understand that the Urban League of Palm Beach County does not guarantee that I/We will receive mortgage financing from any lender and/or other mortgage financing entity.

I/We may be referred to other housing services of the organization, its affiliate(s), and partners and/or to another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me. I/We understand that a counselor may answer questions and provide information but cannot give legal advice. If I want legal advice, I will be referred for appropriate assistance.

I have read and received a copy of the Urban League of Palm Beach County’s Conflict of Interest Policy Statement.

______________________________________ _____________________________

Signature Date

______________________________________ _____________________________

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PRIVACY POLICY

The Urban League of Palm Beach, Inc. is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be managed within legal and ethical considerations. Your “nonpublic personal information,” such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditor, program monitors, funders and other third parties, only with your authorization and signature on the Client Authorization for Counseling Agency form. The agency maintains physical, electronic and procedural safeguards that comply with federal regulation to guard your non-public personal information. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs.

TYPES OF INFORMATION THAT WE GATHER ABOUT YOU

 Information we receive from you orally, on applications or other forms, such as your name, address, social security number, assets, and income.

 Information about your transactions with us, your creditors, others, such as your account balance, payment history, parties to transactions and credit card usage; and

Information we receive from a credit reporting agency, such as your credit history.

YOU MAY OPT-OUT OF CERTAIN DISCLOSURES

1. You have the opportunity to “opt-out” of disclosures of your nonpublic personal information to third parties (such as your creditors), that is, direct us not to make those disclosures.

2. If you choose to “opt-out,” we will not be able to answer questions from your creditors. If at any time, you wish to change your decision with regard to your “opt-out,” you may call us at (561)833-1461 and do so.

RELEASE OF YOU INFORMATION TO THIRD PARTIES

1. So long as you have not opted-out, we may disclose some or all of the information that we collect, as described above to your creditors or third parties where we have determined that it would be helpful to you, would aid us in counseling you, or is a requirement of grant awards which make our services possible.

2. We may also disclose any nonpublic personal information about you or former customers to anyone as permitted by law.

3. Within the organization, we restrict access to nonpublic personal information about you to those employees who need to know that information to provide services to you. We maintain; physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic information.

___________________________________________ __________________________________

Signature Date

___________________________________________ __________________________________

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EDUCATION SERVICES DISCLOSURE STATEMENT

The Urban League of Palm Beach County provides the following housing counseling services: Pre/Post purchase counseling, foreclosure mitigation and default counseling, rental assistance, home buyer education and financial literacy education.

I/We understand that it is my/our right and responsibility to decide whether to engage in any education course with the Urban League of Palm Beach County.

I/We understand that the Urban League of Palm Beach County has the discretion to charge reasonable fees for these education services, and that these fees will be explained to me prior to the education class. I further understand that fees will not be charged if they create a financial hardship and that I will not be denied receiving the education class if I cannot pay the fees.

I/We understand that the Urban League of Palm Beach County provides information on a broad range of housing programs and products, and that the Urban League of Palm Beach County provides rental housing through its affiliate, New Urban Community Development Corporation. The Urban League of

Palm Beach County partners with banks and mortgage providers, fair housing agencies, legal service

providers, insurance providers, foundations, title companies, real estate agents and/or brokerages, and credit counseling service providers. I understand that I am not obligated to choose any particular loan product or housing program discussed in the education classes. I/We understand that the Urban

League of Palm Beach County does not guarantee that I/We will receive mortgage financing from any

mortgage financing entity, or financial products from any financial entity.

I/We may be referred to other housing services of the organization, its affiliate(s), and partners and/or to another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me. I/We understand that a counselor may answer questions and provide information but cannot give legal advice. If I want legal advice, I will be referred for appropriate assistance.

I have reviewed and understand the above Education Services Disclosure Statement.

Client’s signature ___________________________________ Date________________ Counselor signature_________________________________ Date________________

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BUDGET

Income Person 1 Person 2

FORM

Gross Income

Net Income Expenses Current Amt Adjusted Amt Current Amt Adjusted Amt Savings Giving

Savings (Goal) Tithes

Total Charitable Giving

Other

Housing & Utilities Total

Rent/Mortgage

Second Mortgage Miscellaneous & Entertainment

Homeowner Ins. Bank Fees/Checks

Property Taxes Birthday Gifts

Association Dues Books/Magazine/Newspaper

Home Maintenance Camp/Fish/Hunt

Electricity Children Allowance

Gas/Heating Oil Christmas Gift

Telephone Concerts Plays

Water/Sewer/Garbage Film/Developing

Cell Phone Health Club/Training

Cable TV Hobbies

Internet Movie Rentals

Total Music/CDs/Video Games

Pet Care

Transportation Postage

Car Payment(s) School Supplies/Activities

Insurance Sporting Events

Gasoline Tobacco/Alcohol

Licensing Vacations

Public Transportation Other

Maintenance Total

Total

Total Household Expenses

Food

Groceries

School Lunches Other Debts

Meals Out Taxes

Total Student Loans

Credit Cards

Dependent Care Medical Bill

Child Care Furniture Loans

Child Support/Alimony Personal Loans

Tuition Other Total Total Personal Care Medical Medicine Clothing Hair Care

Laundry/Dry Cleaning Total of all Expenses

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SIGN-IN SHEET AND DATA FORM

Urban League of Palm Beach County Homebuyer Education Workshop

1700 Australian Avenue, West Palm Beach, FL 33407

We receive funding for Housing Counseling Programs from Palm Beach County, HUD and National Urban League. Therefore, we are required to gather statistics on the households of persons served by our programs. Data collected will be in accordance with the Urban League privacy policies. Please fill in the information requested below. Thank you for your cooperation.

Your Highest Level of Education: Some High School Some College High School College

Income:

 In the chart below, find your household size.

 In the column for your household size, circle the box that most closely matches the yearly gross income of your household. Annual household income includes the earnings of all working adults, and the income of individuals receiving government or other assistance such as social security, disability, TANF, pensions, retirement, etc.

FY 2014 Income Area Limits Palm Beach County

Median Income Family Size 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons Extremely Low (30%) Income $13,740 $15,690 $17,640 $19,590 $21,180 $22,740 $24,300 $25,860 $ 63,300 Very Low (50%) Income $22,900 $26,150 $29,400 $32,650 $35,300 $37,900 $40,500 $43,100 Low (80%) Income $36,640 $41,840 $47,040 $52,240 $56,480 $60,640 $64,800 $68,960

My household gross income exceeds the income levels stated above for my family size of _______.

I certify that this information is correct to the best of my knowledge.

____________________________________________ __________________________________ Client’s Signature Date

___________________________________________ __________________________________

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EQUAL HOUSING OPPORTUNITY

The Urban League of Palm Beach County, Inc. Does Business in Accordance With All

Federal, State and Local Fair Housing Laws and Ordinances

(The Fair Housing Amendments Act of 1988)

It is Illegal to Discriminate Against Any Person Because of Race, Color, National Origin, Religion,

Sex, Disability or Familial Status. In Addition, Palm Beach County Ordinance includes: Age,

Marital Status, Sexual Identity, Orientation or Expression.

In the sale or rental of housing or residential lots

In advertising the sale or rental of housing

In the financing of housing

In the provision of real estate brokerage services

Anyone who feels he or she has been discriminated against may file a complaint of housing

discrimination at the:

Fair Housing Center of the Greater Palm Beaches, Inc.

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Client Bill of Rights

AS A PROGRAM PARTICIPANT BEING SERVED BY THE URBAN LEAGUE OF PALM BEACH COUNTY, INC., YOU HAVE THE RIGHT TO:

Understand and use these rights. If for any reason you do not understand or need help understanding these rights, the Urban League of Palm Beach County must provide assistance.

Participants will receive services without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation or source of income.

Receive considerate and respectful services from any employee of the Urban League of Palm Beach County.

Complain without fear of reprisals about the care and service you are receiving and to have the Vice President of Programs respond to you, when such a request is made.

Participants will be provided with vital agency contact information, including appropriate supervisor upon request.

Know the names, positions and functions of any Urban League of Palm Beach County employee, volunteer, intern, and/or independent contractor or consultant providing services on behalf of Urban League of Palm Beach County involved in your case.

Participants will be informed as to why they are receiving services and what is expected of them based upon affiliate services and agreements of service.

Refuse service and be told what effect this may have on your case. By refusing services, you are responsible to accept the consequences of your actions.

Staff will have the necessary Release of Information signed by the participants before obtaining any information that pertains to the participant being served by the Urban League of Palm Beach County. All information obtained will be used to assist families towards achieving goals, identifying barriers, receiving status updates, and prevention. Such information will remain confidential between the Urban League of Palm Beach County and the referral agency, if applicable.

Participants are not to exchange any money or gifts for services provided by Urban League of Palm Beach County staff.

Urban League of Palm Beach County staff is not to behave as a Payee, child care provider, or respite provider.

No child is to be transported by Urban League of Palm Beach County staff, without the parent or guardian present or signed Transportation Release and Consent Agreement.

Families receiving transportation that is provided by Urban League of Palm Beach County shall occur within a registered and insured vehicle.

By signing this document, I acknowledge this information has been reviewed ad explained to me. I further understand my rights as a client of the Urban League of Palm Beach County.

________________________________________________ ____________________

Signature of Client Date

________________________________________________ _____________________ Signature of Urban League of Palm Beach County Staff Date

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