By checking the box following this description, you are providing a virtual signature to our informed consent form and agreeing to abide by the following:

• All participants understand that this session is held virtually and must verify their identity by providing a scanned image of their drivers license or other verifiable governmental identification sent from the same email used to join the Zoom session.
• The virtual class links will be sent out the day before the class to the email that is listed on your registration form. You must confirm receipt of the email with the class link.

• To ensure fair access to the HOPE co-parenting class, we have implemented an Attendance and Registration policy. The class requires a minimum of three registered participants. Please only register if you can commit to attending the entire 4-hour workshop.

• Participants are not permitted to make an audio or video recording of any portion of the session. All content shared in this session is confidential, participants must not share members names or personal information. Additionally, participants must attend session in a private location to maintain confidentiality.
• The client is responsible for securing his or her own computer hardware, internet access, and security. Calvary Counseling is not liable for confidentiality breaches due to misconduct of client’s. Calvary Counseling is not responsible for client’s equipment failure, e.g. camera, and/or Internet service.
• Confidentiality Restrictions: The laws that protect the confidentiality of any medical information also apply to this virtual session. Information about the client will only be released with his or her express written permission, with the exceptions of the following cases: the leader determines risk of self-harm or harm to others, or the leader is informed about or suspects abuse, neglect, or exploitation of a minor or of an incapacitated adult. Please note, Calvary Counseling will maintain records of online counseling and/or consultation services.

• I authorize Calvary Counseling Center, Inc to charge the credit card indicated in this authorization transaction according to the terms outlined herein. This payment authorization is for therapeutic behavioral health goods/services described above, for the amount indicated. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit/debit card company; so long as the transaction corresponds to the terms indicated in this form.

• I agree for Calvary Counseling Center to contact me to do an over the phone intake.