INTAKE RELEASE	Date
Client	Meeting Date with Client
Staff	Meeting Date with WSC
Go over each of the releases with the client/guardian at intake or if the client's circumstances change. Maintain a copy in the client's home book and the original in the client's casebook. Ensure that you have a copy with you in the event of required or emergency treatment and transportation.
Individual Client (Print)
Release Authorization for Treatment
Permission is hereby given to any authorized representative of Life's New Beginnings, Inc, to obtain all medical, dental, mental health, surgical, or other procedures (including the giving of anesthetics) which are deemed to be necessary in the event of routine health exams, illness, injury, or other medical emergency for the individual client named.

The individual client/guardian/advocate does hereby release and discharge Life's New Beginnings, Inc., and all persons acting for said agency in the treatment, transportation, or any and all circumstances related to the treatment, from any and all claims, demands, liability, and damage of whatever nature which hereafter may be sustained resulting from said treatment or other care incidental to the treatment.

Should ambulance transportation be deemed necessary, and insurance payment cannot be arranged, the individual client/guardian/advocate agrees to assume financial responsibility for the cost of such transportation.

A copy of this authorization is as valid as the original.

Individual	Signature	Date
Client
Guardian
Advocate/Family
Staff
WSC
Authorized Representatives (print names)

Release Authorization for Transportation
Permission is hereby given to any authorized representative of Life's New Beginnings, Inc., to transport the individual client for the purpose of accessing appointments or activities considered by the client and the professional staff to be an important part of the supported living program.

The individual client/guardian/advocate will not hold any staff of Life's New Beginnings, Inc., or the agency, or any individuals responsible or liable for any mishaps which may occur during transportation and activities. It is understood that the greatest care will be taken to insure the safety and comfort of the individual client.

A copy of this authorization is as valid as the original.

Individual	Signature	Date
Client
Guardian
Advocate/Family
Staff
WSC
Authorized Representatives (print names)