Connection Release
The Connection Program Release of Information (ROI)
Please complete this document in its entirety. This includes providing:
- Full Name
- Date of Birth
- Name, Address, and Phone Number of all individuals to be included in the ROI
- Checking "primary" or "secondary" box
- Signature & date
Upon completion, please fax or mail to:
Hazelden Betty Ford Foundation
Connection Program
PO Box 11, RC1
Center City, MN 55012
Fax: 1-651-213-4224
Connection Guarantor
Connection Financial Guarantor Form
The Connection Program Financial Guarantor Form needs to be completed by the person submitting payment for the Connection Program. Please complete this document in its entirety. This includes providing:
- Full Name, printed
- Signature & date
Upon completion, please fax or mail to:
Hazelden Betty Ford Foundation
Connection Program
PO Box 11, RC1
Center City, MN 55012
Fax: 1-651-213-4224