New Client Agreement Form

SparkHope Automotive is a 501(c)(3) nonprofit with locations in Aurora and Federal Heights, Colorado. Through a supportive community of individuals, businesses, churches, and partners, SparkHope offers long-term automotive services—up to three years—for employed single mothers working to support themselves and their dependent children. If you own your vehicle, SparkHope can assist with repairs, maintenance, and helping you better understand your car. As you receive services, it’s important to be aware of your responsibilities as a client, the benefits available to you, and any service limitations. Above all, our CEO and employees want you to know that you are loved and there is hope.
Please read the following statements, place a checkmark next to each statement, and then sign and date at the bottom of the document.
*
I understand that SparkHope Automotive is a faith-based nonprofit organization. That faith inspires everyone associated with SparkHope to be of service to each and every single mother (Client)who comes seeking help & hope. Reception of services is not dependent on my sharing these faith values.*
*
I understand it is the safety concerns and longevity of the vehicle that are the main focus of this program.*
*
I understand entering the Program and utilizing SparkHope's offered discounts, I must bring in my vehicle three or four times a year for routine maintenance (oil changes & inspections) and/or for vehicle repair(s) to be eligible, the second and/or third year. After the third year, I will graduate from the SHIFT program.*
*
I understand SparkHope is committed to helping me maintain the vehicle’s longevity, but there are no guarantees as vehicles can be mechanically unpredictable and breakdown while I am in the program.*
*
SHIFT clients pay 50% of the retail labor rate for vehicle repairs and maintenance. Please note that SparkHope does not give away free vehicles*
*
I understand that it may not be possible to know the same day of what the cost of repairs will be or how long the repair facility will need to keep my vehicle for repairs. This will be provided after the estimate for repairs needed are approved.*
Check17
I understand that disrespectful behavior (including yelling, cursing and any physical violence) while in the Program will result in my removal and I will no longer be able to utilize the benefits that have been offered to me.
I understand that once my application for services has been approved the following steps will occur:*
My vehicle will be evaluated to determine needed repairs.
*
A cost at the percentage and time estimate will be provided to me.*
*
I will have up to 3 days to authorize the estimate for repairs or pick up my vehicle.*
*
I understand that SparkHope does not provide payment for work that has already been completed or scheduled at outside repair facilities.*
*
I understand that while in the program my vehicle repairs may exceed the value of the vehicle. SparkHope program staff will determine if it is economically feasible to further conduct the repairs on my vehicle or advise me on the best solution regarding the vehicle and my situation in the long run.*
*
I understand that while conducting authorized repairs, additional items needing immediate attention may be discovered. I will be notified of these items and the repair cost and will be asked to approve or decline the additional repairs if staff still believes it is beneficial to complete all repairs.*
Check14*
I understand in the program, my engine and/or transmission cannot be rebuilt, resealed or replaced, if it is recommended.*
Check15*
I understand that in the program, repairs due to an accident, theft, and/or vandalism may or may not be covered. If any incident should occur, I will notify my insurance first before contacting SparkHope staff.*
Check16*
I understand that if my vehicle is used for excessive driving and is driven more than an average of 20,000 miles a year, SparkHope cannot guarantee a program cost for repairs and maintenance while participating in the program.*
To help us understand what matters most to you in having a reliable vehicle, please check the benefits you hope to experience after receiving service through our program:*
- I will be able to maintain employment, which will prevent homelessness and food insecurity.
- I will be able to take child(ren) to school or childcare.
- I will be able to access essential daily living activities (i.e. food shopping, medical appts, etc.)
- I will be able to achieve safety and independence from past/current abuse.
- I will be able to eliminate wasted time caused by long commutes walking, taking multiple public transportation trips to work, school, and/or childcare, and/or waiting for rides.
SparkHope Automotive respects the privacy of all women in our programs. We will not use or publicize information without your consent. All information is intended for the use of communications to donors, businesses and church partners. Promo materials may be shared externally and displayed on our website, e-newsletters or on social media platforms. We may contact you to share your story.
I hereby grant permission to SparkHope Automotive to use my name and child(ren’s) name(s):*
- To be named in quotes, and/or a story.
- Permission to take and use photographs.
- Permission to tape and use audio & video-tapes.
- Permission to publicize a story without the use of my name and child(ren’s) name.
- Please do not use my name or child(ren’s) in any materials as it will endanger us.
Other Permission Notes:
Check25*
I understand that someone from the program will connect with me to ask about the benefits I actually experienced because of the program.*
E-Signature*
Check26*
By typing my name above and submitting this form, I recognize that this constitutes my approved electronic signature.*
Date*
Email*
Phone*