Hope - Court Approved Parent Class Intake
If you have any trouble submitting this form, please download and print the pdf and fax it to us at (703) 530-9805. Download
Please note: Due to the current pandemic all HOPE classes will be held online.
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.
- 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.