Pro Bono Legal Representation Consent Form
Client Information
Full Name:
Address:
Phone Number:
Email Address:
Attorney / Organization Information
Attorney/Organization Name:
Address:
Phone Number:
Email Address:
Case Information
Case Title/Description:
Consent and Acknowledgement
I agree to receive pro bono legal services and understand the scope and limitations of this representation.
I understand that all information shared is subject to attorney-client confidentiality.
I am signing this form voluntarily and have had the opportunity to ask questions.
Client Signature:
Date:
Attorney/Organization Representative Signature:
Date: