Client Signature Date. T2.1.20 EVALUATION SCHEDULE: REPORT ON CONTRACTOR’S COMPETANCE & PERFORMANCE ON A SIMILAR PROJECT FOR TENDER RECOMMENDATION PURPOSES The following are to be completed by the Client and Principal Agent and is to be supported in each case by a letter of award and the works completion certificate. Both Client and Principal Agent must sign and stamp the documents, failure to obtain both signatures and stamps will result in no allocation of points. PROJECT NAME and SCOPE OF WORK: Principal agent:.................................................................................................................................. Client: .. ..............................................................................................................................................
Client Signature Date. (By making a purchase, you agree to have read and agree to the conditions set in this document.) Sacred Elevation Healing LLC
Client Signature Date. If electronically signing, I acknowledge my intent to sign by typing my name and date on signature line above.
Client Signature Date. This authorization is only valid until [fill in date], or until three months after my file is closed at the Untethered Therapy Group. Client Signature Date Witness Date Parent/Guardian Signature (if minor) Date Print Parent/Guardian Name (indicate relationship) AUTHORIZED PERSONS and ENTITIES: Address Name (Initial Here) Phone Email Address Name (Initial Here) Phone Email Address Name (Initial Here) Phone Email VIDEO TAPING CONSENT FORM MentWell Inc., a Pennsylvania Nonprofit Corporation doing business as Untethered Therapy Group (“we,” “us,” or “Untethered Therapy Group”) sometimes makes videotapes and audiotapes of clients and their families. These tapes can be used in different ways. For example, your therapist may use the tapes to (1) privately review the session for clearer understanding and to prepare for the next session; (2) to seek consultation or help with developing more effective treatment strategies; (3) to train other therapists in the models and techniques used here; (4) to obtain higher credentials of proficiency, such as certification, in the models and techniques used. There are several things we would like you to be aware of concerning taping. First, the profession of marriage and family therapy has very clear and strict ethical standards concerning the confidentiality and protection of privacy. Consequently, Untethered Therapy Group has strict policies concerning the discussion of cases during individual and group consultation sessions. Your surname will not be associated with any of the recordings. Your case will not be discussed outside of the clinical settings. Only approved persons will be allowed to watch these tapes. All staff are prohibited from watching tapes of anyone they know even remotely. Second, all tapes will be stored at our offices under secure conditions. Furthermore, tape recordings will be used only for the purposes you xxxx below and are generally erased after four weeks unless special permission has been obtained from you. After any tape is made, I (We) can ask the therapist to see it and can ask the therapist to erase it and all copies of it. Lastly, only some parts of the tape(s) might be used. I (WE) AGREE THAT THE TAPES MAY BE USED IN THE FOLLOWING WAYS: □ to be seen only by my therapist /doctor and his supervisor □ to seek consultation with other professionals □ to teach health care workers or other therapists in classes or professional meetings Please list other restrictions: I (WE) FURTHER AGREE AS FOLLOWS: ...
Client Signature Date. If you do not understand the effects of this agreement, consult your attorney before signing. This is a legally binding contract. Address: 000 Xxxxxx Xx. Suite 100, Irving, TX 75062 Phone: 000.000.0000
Client Signature Date. CLIENT HISTORY If you need more room in answering any questions, please continue on the back of that sheet at about the same space as the question is located on the front.
Client Signature Date. If you do not understand the effects of this agreement, consult your attorney before signing. This is a legally binding contract. Real Estate I & C Solutions Address: 000 Xxxxxx Xx. Suite 100, Irving, TX 75062 Phone: 000.000.0000
Client Signature Date. In the event that I may be incapacitated due to severe injury or death while my pet is under the care of Johnstown Pet Services, I authorize that my pet(s) be turned over to: Name: Daytime Phone: Mobile Phone: Relationship: Evening Phone: E-mail Address: Address: Ready Key Program Client Signature Date I hereby certify that I am providing a key(s) to Johnstown Pet Services. I authorize Johnstown Pet Services to enter my home for pet sitting services, upon my request via telephone, email, or in person. I also understand that Johnstown Pet Services will retain my key(s) for use the next time services are needed. I understand that keys will not be left at my house and I will be charged a fee of $5.00 to return key(s). I release Johnstown Pet Services from any liability connected to the detainment of my house keys. My signature below indicated agreement to these terms. Client Signature Date Consultation fee $20: Key tag color: Service Agreement This pet sitting service agreement is made between Johnstown Pet Services and hereinafter referred to as “JPS”, and the below named Client, hereinafter referred to a “Client” for pet sitting services.
Client Signature Date. Client 2 Name …………………………………………... Client Signature .............................. Date ..................... Signed on behalf of firm Advisers Name …………………………………………. Advisers Signature ............................. Date …………………. Declaration (Adviser copy) This is our standard client agreement upon which we intend to rely. For your own benefit and protection, you should read these terms carefully before signing them. If you do not understand any point please ask for further information. This agreement supersedes any previous Client Fee Agreement made with the firm. Please tick this box if you do not consent to us or any company associated with us processing any such sensitive data. Please tick this box if you do not wish for us or any company associated with us to contact you for marketing purposes by e-mail, telephone, post or SMS. I/We are aware of the costs of the Initial Financial Planning Fee and Recommendation(s) and where appropriate, the policy or investment arrangement and implementation services and agree to the method and timing of these. Initial Financial Planning Fee agreed is The payment option agreed is ticked below: Direct payment Deduction from the policy /platform / Wrap only (where possible) If a direct payment is chosen, the fee will be payable at the same time the investments are implemented. You should note that when paid through the investments it may reduce your personal tax thresholds and/or exemption levels. Where this happens we will discuss it with you and confirm it in your personal recommendation report. All invoices issued are to be settled within 21 days of issue. This agreement may be terminated at any time without penalty, by either party, subject to any outstanding fees having been paid in full. Termination should be placed in writing by either party. Client 1 Name …………………………………………... Client Signature .............................. Date ..................... Client 2 Name …………………………………………... Client Signature .............................. Date ..................... Signed on behalf of firm Advisers Name …………………………………………. Advisers Signature ............................. Date …………………. NB: In relation to your chosen level of on-going service this will be agreed separately within our Service Proposition & Engagement document that follows. On-going Service Agreement (Adviser copy) I/We would like to subscribe to the following on-going service option: (Please tick the relevant box to indicate your agreement) Wealth Management Se...
Client Signature Date. Client 2 Name …………………………………………... Client Signature .............................. Date ..................... Signed on behalf of firm
