MEMBER CONSENT TO ELECTRONIC TRANSMISSION

As an Applicant and Participant of Haven Homes Foundation (“Foundation”) Recovery Residences, you must provide written consent in order to receive official communications from, and to send official communications to, the Foundation via electronic transmission (cellular, fax or e-mail).

This consent form will allow Haven Homes Foundation to send you application questionnaires, rules and procedures, Foundation policies, payment and invoice information and provide you with copies of other Foundation documents by electronic transmission (cellular, fax or e-mail). It also allows you to send the same types of information to the Foundation via fax or e-mail.

Before signing this consent form, please review and be aware of the following:

1. You are not required to sign this form. You may request that meeting notices and other matters of official business be sent to you via regular mail.

2. You have the right to withdraw your written consent at any time after signing this form by providing the Foundation with written notice that you are withdrawing your consent relative to electronic transmission. No fee will be charged for withdrawing your consent.

3. This consent to electronic transmission is broad and may include transmission of other important information regarding the Foundation. This consent form represents consent under California Corporations Code Section 20 (transmission from and to the Foundation). This consent form also meets the requirements for consent under the federal Electronic Signatures in Global and National Commerce Act (15 U.S.C. Sec. 7001(c)(1)).

4. Consenting to electronic transmission via cellular phone and SMS requires that you have access to a cellular phone and have a current phone number on file with Haven Homes Foundation.  The Foundation is not responsible for cellular carrier data charges.

5. Consenting to electronic transmission via fax requires that you have access to a fax machine and have a current fax number on file with Haven Homes Foundation.

6. Consenting to electronic transmission via e-mail requires that you have access to a computer, have a current e-mail account in your name, and have provided your current e-mail address to the Foundation.

By checking the associated block, the Applicant/Participant has read and understands the foregoing, and hereby provides this written consent to receive and send information, including but not necessarily limited to questionnaires, rules and procedures, Foundation policies, payment and invoice information, and other information regarding the Foundation, via electronic transmission (fax and/or e-mail), until such time as this consent is revoked in writing.