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About
History
Resources
Contact Us
News & Updates
Programs
Programs
Helping Hub
Education
Hunger Prevention
Seasonal Needs
Instructional Support
Family Support
The Bridge of Estes
Events
Events Calendar
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Client Agreement/Information Release Form
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Client Agreement
I request to become a client of Crossroads Ministry of Estes Park, and I agree to the following:
1. I understand that I am entitled to be treated with dignity, respect and courtesy by every employee and volunteer at Crossroads Ministry.
2. I agree to treat every employee and volunteer of Crossroads Ministry with dignity, respect and courtesy.
3. I understand that I am entitled to nothing from Crossroads Ministry, and that the ministry is not required to meet any of my requests.
4. I will be truthful, honest and complete in answering all questions on the Crossroads Ministry Client Information Sheet and will notify Crossroads Ministry of any changes.
5. I understand that I am not allowed to authorize any person living outside my household to seek services in my name.
6. I understand that if any Crossroads Ministry employee or volunteer deems that I am under the
influence of any substance that services will be denied to me at that time.
7. I understand that Crossroads Ministry’s staff has a responsibility to call appropriate law enforcement authorities if I attempt to drive off the premises while under the influence of drugs and/or alcohol.
8. I understand that Crossroads Ministry’s staff has a responsibility to report any suspected occurrence of child abuse, child neglect, elderly abuse or elderly neglect to the appropriate authorities.
9. I understand that Crossroads Ministry’s staff has a responsibility to contact local law enforcement authorities if I make any threat to do harm to myself or another individual.
10. I understand that I have a responsibility to provide all requested information and documentation in a timely manner.
11. I understand that some of the food products I receive are perishable and require refrigeration, and that if I fail to refrigerate or prepare the food properly, Crossroads Ministry is not responsible.
I agree and understand that it is my duty to comply with all parts of this agreement. I also understand that my failure to comply with this agreement could result in the termination of all services I receive from Crossroads Ministry.
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INFORMATION RELEASE
I, the undersigned, authorize Crossroads Ministry of Estes Park to exchange information about me or my household members for the purpose of providing assistance to me, verifying the information I have provided, performing a background check, and verifying information I have provided to partner agencies and individuals. This information release also extends to any follow up that may be necessary between Crossroads Ministry of Estes Park and any individual, agency or vendor who provides services to me. I also agree that Crossroads Ministry of Estes Park may exchange information about me with other similar institutions and agencies to alleviate any duplication of services. I authorize such person, agency, or institution to provide such information requested by Crossroads Ministry of Estes Park. I release any/all persons, agencies and institutions from any liability for supplying such information.
This agreement is valid through December 31, 2025.
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