By providing my information and signature, I am saying that I understand the following:
* One-day classes are not 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.
* In a crisis or emergency situation, that needs immediate attention, where I am considering seriously harming myself or someone else, I will call the National Suicide Hotline at 988, dial 911 or go to the emergency room.
A. I am choosing to complete my one-day class requirement via the online platform called ZOOM. ZOOM is a tool allowing for face-to-face video, voice, or text-based chat. ZOOM is encrypted using the same standards utilized by the US government to protect sensitive information.
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 at 9:00am or 1:30pm and runs up to 4 hours. I need to stay for the whole class.
D. I will log in 5 minutes early for class and wait for my teacher to check me into the classroom.
E. I will give 24 hours notice by phone or email (a voicemail is ok with 24 hours notice) to reschedule. If I miss the class I forfeit the full fee/cost of the class. If I have a voucher, I will be responsible for the full amount of the class. In order to reschedule I will pay the amount that I owe and the cost for the additional class in order to reschedule.
F. I will have good quality Internet, video, and sound at all times.
G. I will be in a quiet and private space for at least 4 hours. Driving or being in a public place is not allowed.
H. Recording or taking pictures of any part of the class is not allowed.
I. No other person is allowed to attend the class with me. This includes parents, spouses, domestic partners, siblings, or friends. If am not alone, I will be removed from the class.
J. Virtual backgrounds are not allowed.
K. I will not use drugs or smoke of any type during class.
L. I will pay for my class when signing up or I will email my probation officer about a voucher. Paying for the class is the only way to get the link for the class.
M. The link is emailed to the email address I give when I register. The link is emailed the week of class. I will check my junk/spam folder if I do not see it in my inbox.
For questions or concerns about any of the above, please email us at change@nichange.com. All questions or concerns about the class must be emailed by Thursday at 5pm. The office is closed Friday - Sunday.