Service Member

JC Membership Request ********.docx ********

Joseph’s Coat Membership Application

Primary adult member must be at least 18 years old Primary Adult Name Date Email Phone Address City State No. of Registered Family Members Zip I.D. verified by Bring I.D. for Each Person in Household the First Time You Visit ADULT I.D.- Government issued ID with address and birth date. CHILD I. D. - Birth certificate or insurance card with birth date. You must have legal custody of children. Joseph’s Coat Membership is required for furniture requests. Joseph’s Coat Membership Guidelines

Observe limits. Clothing limits reset monthly.

Children must be under your direct supervision.

Respect others: Follow the Golden Rule

Keep clothes on hangers.

Joseph’s Coat reserves the right to refuse service to any individual based on the needs of the organization. My signature indicates that I have read & understand the above and will use the Joseph’s Coat premises strictly according to these guidelines. I understand that, by my signature, I hereby relieve Joseph’s Coat of Central Ohio, Inc., its volunteers, staff and Board members of all liability for injuries to myself and others I may bring onto the Joseph’s Coat premises. Primary Adult Signature Date

List primary adult & household members for whom you will be shopping. Name:

First & Last

M/F

Date of Birth

(Month/Day/Year)

Age

ID Verified

By J.C.

Primary Adult

last name, first josephs-coat.org

2016 JC Request for Membership Gold Form.docx 12/20/16 Additional Family Members Primary Adult Name Name (PRINT)

First & Last Name

M/F Date of Birth

(Month/Day/Year)

Age ID

Verified

Notes:

Contact this candidate