 |
 |
| |
|
WCS Advocate Insurance Agreement |
| I, ____________________________ have been advised that I may be required to transport clients occasionally. I agree to insure any passenger vehicle I may use for this purpose with medical payments coverage. This is for my protection and the protection of the client. Signature:________________________________________ Date:_____________________________________________ Witnessed:_______________________________________ *Please attach to proof of insurance.* |
| Women's Crisis Services is a Monadnock United Way Agency. Women's Crisis Services of the Monadnock Region, 12 Court St. Keene, NH. 03431 Women's Crisis Services of the Monadnock Region, 47 Peterborough St. Suite B, Jaffrey, NH. 03452 All graphics are the property of Women's Crisis Service's of the Monadnock Region, and New Hampshire Coalition Against Domestic and Sexual Violence, © Copyright 2002 |
| Web site designed by Trudy Emmerick |