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Please indicate your relationship to Florence Crittenton*:---ClientResidentStudent of Crittenton Youth AcademyRelative of Resident/Client/StudentFlo’s on 7th ShopperVolunteerThe AmazingRoad RallyDonorBoard MemberEvent AttendeeOther – please explain in comments section

Your story is very important to us and we would like your permission to share it with others as appropriate. Please read each of the following paragraphs carefully and check the box below to allow Florence Crittenton, our agents and representatives to publish your story in whole or in part. Thanks in advance for allowing your experience to become part of Florence Crittenton’s story!

I give Florence Crittenton permission to use my first name and first initial of my last name, together with my testimonial, which may appear in any printed material distributed by Florence Crittenton, or on the Florence Crittenton website. I hereby authorize Florence Crittenton and its agents, representatives, and assignees to use, reproduce, exhibit, broadcast and distribute any materials containing my name and testimonial, without limitation, for the purpose of endorsing Florence Crittenton and the services it provides.

I grant permission to use all or any part of my testimonial as indicated above and to edit the testimonial as Florence Crittenton thinks necessary, provided that such editing does not materially change the information or viewpoint I provided

I hereby certify that my testimonial or endorsement of the service(s) Florence Crittenton provides is true and accurate and reflects my honest belief in the quality of the service(s) that I am endorsing.

*By checking this box I certify that I have read the statements above, and knowingly and willingly release my story for use by Florence Crittenton..

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