Consumer Rights Consumer RightsUtah law requires that we inform you of the following consumer rights that you have: You have a right to privacy of information and privacy for current and closed records. Act of Love shall take reasonable precautions to ensure the privacy of your confidential information as required by Utah law, unless you expressly agree to Act of Love’s disclosure of such information to a third party. This assurance of privacy also applies to both current and closed records.You have the right to obtain the reasons for involuntary termination of services and the criteria for re-admission to the program. If Act of Love terminates its agreement to provide services to you and you notify Act of Love within a reasonable time period that services were discontinued against your will, within 20 business days of when Act of Love receives such notification you are entitled to a written explanation of the reasons for involuntary termination of services as well as notice of the criteria for re-admission to the program if re-admission is deemed feasible.You have the right to freedom from potential harm or acts of violence to you or others.You have the right to be free from unlawful discrimination.You have the right to be treated with dignity.You have the right to communicate by telephone or in writing with your family, attorney, physician, clergyman, and counselor or case manager, except when contraindicated by a licensed clinical professional.You have the right to send and receive mail providing that security and general health and safety requirements are met.You have the responsibility to be honest and forthright in your dealings with the agents, employees, and other clients of Act of Love.You have the responsibility to never act in a way that would jeopardize or compromise the safety of any person or property while receiving services from Act of Love.Smoking is not allowed on any property owned, leased, or managed by Act of Love.Service fees and costs are usually born by the adoptive families. Birth parents usually do not pay any fees, but we will advise you if your situation presents different circumstances and present you with a schedule of fees and costs.Grievance and complaint procedures. If you believe that an agent or representative of Act of Love has violated your consumer rights, you may send a written complaint to: Act of Love, Consumer Rights Complaint, 9561 South 700 East, Suite 101, Sandy, Utah 84070. Act of Love will initially attempt to resolve the matter formally with you. Act of Love may make such informal efforts for up to 60 days. If Act of Love is not able to informally resolve the complaint, you will receive a written response within twenty business days after Act of Love has ended its efforts to resolve the matter informally.I/we, certify to the best of my knowledge that I/we have read the foregoing and I/we am/are signing this of my own free will.By signing these documents electronically, I/we acknowledge that the electronic mark or symbol used to sign is representative of, functionally equivalent to, and shall be treated exactly the same as my/our handwritten signature(s). By making such a mark, I/we affirm that I/we do so with the intent to sign the forms or records so marked. I/we understand that by signing these documents electronically I/we will be bound by the terms of the documents, the same as if I/we had signed with my/our handwritten signature(s). Birth Mother Signature Date Birth Father Signature (If applicable) Date A Act of Love ·9561 South 700 East, Suite 101, Sandy, Utah 84070·(801) 572-1696·Fax (801) 572-9303 24-Hour Birth Parent Line 1-800-835-6360 ©Copyright A Act of Love 2010 Please leave this field empty.