Please
inform the Employee doing your Intake. The Intake Coordinator will also be discussing the Navigation Centers rules, boundaries, and expectations for your stay with us.
Walk up
and staff permits,
_____Family Reunification Services
Is Faith important to you? ____ yes _____ no
If yes, is their currently any faith based organizations, that are currently helping you with your current situation and if so, can you name them? (All support helps!) ________________________________________________________________ ________________________________________________________________
Are you positive for any communicable disease that could be transferred to others at the Navigation Center? _____ yes _____ no
Or Someone that may be willing to help you in your current situation?) I _________________________ agree that I provided honest answers to the (client name)questions mentioned in this form.
Client signature____________________________ Date:__________________