IF YOU NEED TO SCHEDULE AN INTAKE, EVALUATION, OR WEEKLY CLASSES, STOP HERE AND CALL 303-231-0090 x1 TO SCHEDULE AN APPOINTMENT. DO NOT FILL OUT THIS FORM. THIS FORM IS FOR ONE-DAY CLASSES ONLY.
By providing my information and signature below, I acknowledge and understand the following:
A. I am choosing to complete my one-day class requirement via the online platform called ZOOM with National Institute for Change, P.C. ZOOM is an online communication tool allowing for face-to-face video, voice, or text-based chat dialogue. ZOOM is encrypted using the same standards utilized by the US government to protect sensitive information.
(We highly recommend creating an account (if using a computer) https://zoom.us or downloading the app (if using your phone) before your class day so you have some time to familiarize yourself with it if you have not used it before. For a test run of the Zoom tech, please click here: https://zoom.us/test and if you run into any trouble, you may contact them directly at +1-888-799-9666 or email@example.com.)
B. Limitations of ZOOM video sessions: Any internet based communication is not 100% guaranteed to be secure/confidential. I agree that National Institute for Change will not be held responsible if any outside party gains access to ZOOM personal or confidential information by bypassing their security measures. Also, technical problems could occur. If the class is disrupted, the teacher will attempt to reconnect within 10 minutes. If reconnection cannot occur, the class will be rescheduled as soon as possible.
C. Class starts promptly at 9:00 am and runs approximately 4 hours. The full length of the class will be determined, by the teacher, the day of class as it varies according to class size. No guarantee of early dismissal can be made so, if I cannot attend the full length of the class, I will email the office to reschedule.
D. I am responsible for joining the class at the scheduled time, which is 9:00am, and I should plan to log in at least 5 minutes early to ensure that I am able to access the virtual classroom. The classroom closes at 9:05 and no one will be permitted to enter after that time.
E. If I am not able to attend the class, I will give 24 hours notice (by phone or email) of rescheduling or pay the $35 rescheduling fee. A no-show and logging in after 9:05am will be cause for rescheduling and the rescheduling fee.
F. Class participation is required. I will have good quality Internet, video, and audio at all times.
G. I will be prepared, in a quiet and private space, free of all outside distractions and will utilize headphones for additional security for at least 4 hours.
H. Confidentiality is expected: Recording or photographic imaging of any part of the class session is strictly prohibited. For privacy considerations, no other person is allowed to attend the class with me. This includes parents, spouses, domestic partners, siblings, friends, etc. Virtual backgrounds are not permitted in this class.
I. I will be free of substances, including medical marijuana, and refrain from smoking of any type during class.
J. One-day classes are not psychotherapy or mental health counseling. No representation of treatment is implied or made as a result of participating in this class. All counseling services offered at National Institute for Change, P.C. are governed under a separate agreement.
K. In a crisis or emergency situation, that needs immediate attention, whereby I am considering seriously harming myself or someone else, I will call the National Suicide Hotline at 800-784-2433, dial 911 or go to a mental health hospital/ER.
L. Payment is required to confirm my seat and receive the link for class. Seating is limited and classes close 10 days before the date of the class or when all the seats are full, whichever comes first.
M. Once registration and payment are received, an appointment reminder with the link for the class will be emailed to the email address provided. This takes place the week of class and no later than two day before the class date. I know to look in my junk/spam folder if I do not see it in my inbox.
N. In order to complete the entire course, and receive a certificate of completion, a follow up quiz will be required and I will complete it online within 3 days of the class. A passing score of 70% or higher is needed to receive a certificate of completion, which will be automatically emailed to me. Further, if I fail to complete the quiz, within the given timeframe, I will be required to retake the class at my expense.
For questions or concerns about any of the above, please email us at firstname.lastname@example.org. All questions or concerns about the class you need to attend should be addressed by the Thursday before the class. The office is closed Friday - Sunday.