I acknowledge participation in Black River Area Development Corporation's (BRAD) Individualized Case Management System, aimed at fostering self-sufficiency through goal-setting based on needs and strengths.
I consent to periodic contact with my Case Manager, understanding that non-compliance or lack of progress may result in release from the program.
I also grant permission for the use of my images in agency media, with the option to opt out before any event.
I authorize the release of information for verification purposes, and this agreement remains effective until rescinded or upon successful transition to self-reliance.
I affirm the accuracy of information provided to the agency about myself and my household.
I acknowledge the importance of privacy and confidentiality and understand that the program will adhere to all applicable laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA), in the handling of any protected health information (PHI) that may be involved in my participation in the program.
