New Client Form - Wylie Christian Care Center

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 Male
 Female










For Financial Aid fill out the next two sections. Make sure you indicate which rent or utility bill you need paid.
Income Source (Dollars per Month , Net Take-Home)





Expenses (Dollars per Month)








I acknowledge that the Wylie Community Christian Care center is a charitable, non-profit organization and I waive all rights, both for myself and the persons shown above, to seek damages for any act on behalf of the agents of the center, whether such act or omission is negligent or willful, regardless of cause, which may occur. I also agree to grant permission to share this information with other organizations to better serve me and my needs.
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