CAFTH Emergency Shelter Program

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This form is to register your agency as a referring partner in the CAFTH Emergency Shelter Program. This form ensures all staff making referrals understand the policies. It also allows CAFTH staff to have an up to date contact list for all case managers. If you have questions about this form, please contact Stephanie Reyes (stephanie@cafth.org).

What is your name? *

What agency are you from? *

What is your title? *

What is your email? *

Please read and acknowledge the following by checking each box: *

I will provide correct information about my client to the best of my ability.

I will inform my clients that they are fully responsible for any damage to the room, or any additional charges requested beyond the cost of the room for the agreed upon dates.

I will inform my clients that they are only approved for the agreed upon dates of stay and any dates past those agreed upon dates will be charged directly to the client.

I will inform my clients that no other person is allowed in the room unless they are on the referral and have been approved ahead of time.

I will inform my clients that they should not use this room to do anything illegal and if they are found to have any illegal activities taking place in the room, the hotel will remove them.

I will inform my clients that there are no pets allowed in the hotel room.

I understand that I must remain in contact with my client throughout the duration of their stay. If I am unable to get in touch with them for a reasonable amount of time, I will inform CAFTH staff.

Required

By typing your name in the box below, you are agreeing to follow all polices listed above for the CAFTH Emergency Shelter Program. *

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