Acknowledgement of Receipt of Notice of Privacy Practices

Dear Sheltering Arms Volunteer,

Attached is a copy of Sheltering Arms Senior Services’ Notice of Privacy Practices. This copy is yours to keep. It is required that Sheltering Arms document that we have provided a copy of those rights to each of our volunteers. You are required to do nothing but receive this copy, but we do recommend that you read and keep it.

To help us meet our requirement under Federal regulations,

Submitting this form acknowledges only that you have received a copy of Sheltering Arms Senior Services’ Notice of Privacy Practices.

All Sheltering Arms’ clients have also received this information. Thank you so much for your cooperation. Your support enables us to continue to provide the highest quality service to all of our clients. If you have any questions, please call our Privacy Official at 713-558-6400.

I acknowledge that I have received a copy of Sheltering Arms Senior Services’ Notice of Privacy
Practices.