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info@khkc.org2025 Kids Collaborative Information Release Form
By signing below, I give Keene Housing / Southwestern Community Services permission to provide the Keene Housing Kids Collaborative with information to confirm that my family lives in housing owned or managed by Keene Housing, including the Housing Choice voucher program or Southwestern Community Services. I also give Keene Housing Kids Collaborative partner organizations permission to share information regarding participation by my children (listed below) in any program accessed through Keene Housing Kids Collaborative. I understand that this information may include, but not be limited to: invoicing, attendance, academic or behavior information or surveys completed by staff. All information will be used solely to evaluate program impact and quality and will have no bearing on my child's participation in any program offered by any KHKC partner organization. I understand that this permission can be revoked by me at any time.

I hereby allow Kids Collaborative to add my email and cell phone to their distribution lists to receive emails and texts about Kids Collaborative offerings. I understand that my contact information will be used only for Kids Collaborative communications, my information will be stored securely and not shared or sold, I can opt out of texts at any time by replying “STOP”, message frequency may vary and that standard message and data rates may apply. For questions or to update my preferences, I can contact info@khkc.org.  

Mobile contact information will not be shared with any third party or affiliates for marketing/promotional purposes. Any Privacy Policy sections discussing information sharing exclude messaging opt-in and consent, that information will not be shared with any third parties.
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Email *
Housing Program *
Head of Household Full Legal Name *
Second Parent/Guardian Full Legal Name
Address *
Phone Number *
Cell Phone Number *
Are you a Single Parent  *
Is your household receiving services from another agency? *
If yes, which agencies are you working with?
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