ChangeMakers Retainer Form
This Advocacy Agreement is between the advocacy department of ChangeMakers Fort Wayne and the signed respondent below.

This contract does not in any way guarantee the services of the advocate department. This contract simply serves as a waiver of confidentiality in regards to any meetings or documents shared between the involved parties. This waiver permits ChangeMakers Fort Wayne to represent you and any parties involved during phone or e-mail discussions and to participate in meetings, Resolution Sessions, and Hearings. It also allows ChangeMakers Fort Wayne to contact personnel directly to discuss your case. This contract is only considered enforceable upon receipt of an Incident Form Review, a signed Advocacy Agreement Form, and a signed Media Release Statement.  

*Please thoroughly read this statement as you will be held to the terms stated in them. It is expressly understood that this service is not to be construed as legal advice or legal services.
It is understood ChangeMakers Fort Wayne is serving in the role of advocate or co-advocate with you on and on your behalf. In signing this contract, respondents understand that there are no guarantees of success in obtaining the outcome desired. The respondents agree to hold ChangeMakers and its advocates harmless with regard to the outcome of advocacy hearings and mediation.

** Please be advised that clients who choose not to include CMF in meetings, conversations, and hearings could possibly sever their contract with us and are subject to a mandatory 30-minute office appointment before being accepted back as a client. There are exceptions to this rule, but those exceptions are determined by the advocate and Executive Board on a case-by-case basis. This rule is intended to prevent complications with your case and to keep CMF informed and involved with all aspects of the case. Failure to comply with this rule can result in termination of your client status. CMF reserves the right not to take back clients who do not abide by these rules.

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Do you agree to allow ChangeMakers to act on your behalf or on your child's behalf?
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Media Release Statement
I hereby grant permission to ChangeMakers Fort Wayne to speak for and represent me and any parties involved in my case in the media. This includes but is not limited to Videos, Email Blasts, Recruiting Brochures, Newsletters, Magazines, General Publications, websites and/or Affiliates, and Social Media.
Client Name
Date
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