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Use of Program Room
Request Form

The Program Room is available for House of Homes residents to use for child visitations and meetings with service providers or other workers. All meetings and visitations must be scheduled in advance and take place during Fresh Start Support Services’ regular staff office hours. Please complete the form below to request use of the Program Room. Submitting a request does not guarantee availability or approval.​

Client Information

Request Details

What would you like to use the program room for?
Child Visitation
Meeting with Worker
Other

Date & Time

Requested Date
Year
Month
Day
Start Time
Time
HoursMinutes
End Time
Time
HoursMinutes

Agreement/Expectations

  • I understand that submitting this form does not guarantee that my request is approved.

  • I understand that use of the program room must be approved by Fresh Start Support Services staff.

  • I agree to leave the room clean, tidy, and in the same condition in which I found it.

  • I understand that I am responsible for supervising my children and guests while using the room.

  • I agree to follow all House of Homes rules and expectations while using the space.

  • I understand that I am responsible for any damage caused by myself or my guests.

  • I understand that my request may be declined if the room is already booked or if the requested use is not appropriate for the space.

  • I agree to notify staff if I need to cancel my reservation.

Final Submission

How would you like staff to notify you to confirm or deny use of space?
Call
Text
Email

©2019 by Fresh Start Support Services   |   All Rights Reserved   |   Charitable Registration Number 107884074RR0001

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