Participant Responsibility Agreement

Participant Intake Form Requirement

Every participant must complete this form before attending class.

BUSI Participant Intake & Agreement Form (PDF)

This form documents:

• Identity information
• Court referral information
• Emergency contact
• Behavior agreement
• Program understanding (not therapy)
• Payment acknowledgment
• Liability notice
• Signed consent

Never allow someone into class without this completed first.

This single document prevents most future problems.

Participant Commitments

• I will provide accurate contact information and respond to scheduling updates in a timely manner.
• I will ensure reasonable access to the property or service location at the agreed service time.
• I will disclose known safety concerns before volunteers begin work.
• I understand BUSI may prioritize urgent needs, which can affect timeline estimates.
• I will maintain repaired areas and follow basic upkeep guidance to help preserve service outcomes.
• I understand BUSI services are ministry support efforts and not a commercial warranty contract.
• I agree to communicate respectfully with volunteers, staff, and partner providers.

Community Growth Commitment

As part of BUSI's stewardship model, I agree to refer up to three (3) individuals or households who may benefit from BUSI services, when reasonably able.

• Referrals should be made in good faith with accurate information when possible.
• This referral commitment supports community growth and ministry outreach.
• In cases of hardship, disability, safety concerns, or limited network access, inability to refer others will not automatically disqualify support.

Referral 1 (Name and Phone/Email) Referral 2 (Name and Phone/Email) Referral 3 (Name and Phone/Email)

Agreement Acknowledgment

Participant Full Name Date Participant Signature (type full name) BUSI Representative Name Representative Date Print / Save PDF Back to Request Assistance

"No voice nor invoice will go unheard."