SMS Consent Form
The Power of U, Inc. | Uplift Comprehensive Services
This is a blank copy of our signed-paper consent form. This page does not collect or submit online consent. View the printable blank form.
Choose which organizations may text you and which message types you want. The Power of U, Inc. manages administrative communications for Uplift Comprehensive Services. Both use the same messaging system. Each choice is optional; leave a box blank to decline.
Recipient name: ____________________________________
Mobile number receiving texts: __________________________
Your optional choices
By checking a box and signing below, I consent to recurring SMS/MMS messages at the mobile number above from the named organization for the selected purpose. Messages may be sent manually or using automated technology.
☐ The Power of U, Inc. — Service and administrative messages about scheduling, program participation, work or vendor coordination, and responses to my questions.
☐ Uplift Comprehensive Services — Service and administrative messages about scheduling, program participation, work or vendor coordination, and responses to my questions.
☐ The Power of U, Inc. — Promotional messages about programs, community events, opportunities to participate, and fundraising or donation requests.
☐ Uplift Comprehensive Services — Promotional messages about programs, community events, opportunities to participate, and fundraising or donation requests.
Texting terms and privacy
Participation is voluntary. Consent is not a condition of purchasing anything, making a donation, or receiving care or services. I may select any combination or none. Signing alone does not authorize an unchecked option.
Message frequency varies. Message and data rates may apply. Reply STOP to stop texts or HELP for assistance. I may also withdraw consent through the support contact below. A final opt-out confirmation may be sent. A STOP reply may block multiple message types sent from the same number; staff can explain other ways to stay in contact. Delivery is not guaranteed.
Mobile numbers and texting consent will not be sold or shared with third parties or affiliates for their marketing or promotional use. Messaging providers may process information to deliver and support the texts. Permission for one named organization does not authorize marketing from the other.
Ordinary text messages may be seen by others with access to my phone and may not be secure. I should not send medical details or other sensitive information by text. This form is not an authorization to release health records. Texting is not for emergencies; call 911 for an emergency.
Support email: support@upliftnc.org
Signature
I am the subscriber or authorized user of this mobile number. I have reviewed the terms above and had access to the linked policies. My signature confirms only the choices I checked. I will notify the organization if my number changes.
Signature: __________________________ Date: ______________
If signing for another person, name and authority: ______________________________