To help us best accommodate the applicant, please answer the following questions as accurately as possible.
I, First Name* Last Name* being the parent/guardian of First Name* Last Name* give consent for emergency medical and/or surgical treatment in a licensed medical facility and by a licensed physician should my child’s condition require it in my absence. I understand that in such a case, reasonable attempts would first be made to contact me, with time and conditions permitting. As long as the medical and/or surgical treatment considered necessary in the situation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, no specific prohibitions regarding treatment are imposed unless stated here: Enter specific prohibitions regarding treatment here if applicable
By signing below, I give C-HOPE permission to use photographs, audio and/or video recordings of me for marketing and/or fundraising purposes. This includes promotional videos, websites, brochures, newsletters, and similar marketing materials/media. C-HOPE respects the privacy of its participants and does not knowingly allow unauthorized visitors to take images of participants.
RELEASE OF OWNERSHIP
By signing below, I assume no ownership of any product I produce or assist with producing. This includes sales of projects that showcase the talent of C-HOPE participants.
RELEASE OF LIABILITY
I hereby release and hold harmless C-HOPE, Inc., its officers, directors, employees, agents, representatives, volunteers, heirs, executors, and assigns from all liability for personal injury, including death, as well as all property damage or loss arising out of my/my child’s participation in this program and any travel/transportation-related to this program, whether paid for by myself or by C-HOPE. I understand that this release and indemnification releases liability for the conduct of C-HOPE and its officers, directors, employees, agents, representatives, volunteers, heirs, executors, and assigns. Information on program participants’ progress may be collected and used in aggregate form in non-identifying ways to measure and demonstrate the efficacy of C-HOPE programs.
I understand that C-HOPE charges per session attended at a rate of $35 / session hour. For 2 hour programs, the session rate is $70. For 2.5 hour programs, the session rate is $87.50. Invoices will be sent via email at the end of each month if any sessions were attended during that month. Payment must be received within 30 days of receipt of the invoice. After an invoicehas been overdue for 30 days, a mailed letter will be sent. After 60 days, a certified letter will sent. After 90 days we will charge a 3.5% late fee per month. In addition to the late fee, after an invoice has been overdue for 90 days, participants will not be able to attend future program sessions until their overdue balance is paid off.
Programs are open to individuals of all abilities, age 18+, unless otherwise specified. C-HOPE programs are appropriate for individuals with challenging life circumstances whose interests are aligned with the activities and opportunities this program provides.
PROGRAM DATES AND TIMES
Please see our website for specific dates and times of each program.
All enrollment is first-come, first-served for individuals who meet eligibility and screening criteria.
Due to the unique nature of C-HOPE program and the goals of building friendships and social skills, a priority enrollment period is given to returning participants. This consideration is at the discretion of the program instructor, in consultation with the Executive Director, and takes into account how an individual has adapted to the program in the past.
A $10 non-refundable application processing fee is required for new C-HOPE participants. Application fees for returning participants are waived. Spaces are limited - apply early!
PERSONAL CARE AIDE
Unless otherwise specified, program participants requiring the assistance of an aide for personal care must provide their own personal aide. C-HOPE is not equipped to provide this level of assistance. A participant who requires a personal aide but does not provide one may not participate in C-HOPE programs.
Unless otherwise indicated, medications may not be administered by C-HOPE staff. When applicable, participants may provide documentation from their doctor stating the participant’s need and ability to self-carry and/or self-administer prescribed medication.
We are concerned for the health and well-being of everyone involved in C-HOPE programs. Participants must stay home if they are sick.
Safety is of the utmost importance within C-HOPE programs. If a program participant consistently demonstrates excessively disruptive, violent, and/or aggressive behavior that puts the health and safety of others at risk, every reasonable attempt to modify the behavior will be made. However C-HOPE reserves the right to dismiss a participant from
C-HOPE programs if they do not comply. In the event of program dismissal, the balance of registration fees will be refunded only if C-HOPE is able to find another eligible participant to complete the remainder of the program.
Because participant safety is of critical importance, C-HOPE reserves the right to modify, suspend, or cancel any C-HOPE-sponsored session, should such a decision be warranted by a change in health or safety conditions.
In the event of session cancellation due to weather or other health or safety concerns beyond C-HOPE’s control, C-HOPE will make reasonable efforts to reschedule the affected session(s), but cannot guarantee refunds or rescheduling. In the event a COVID shutdown is necessary, the program will be held virtually.
In the event of under enrollment, C-HOPE reserves the right to cancel programs. C-HOPE will refund any and all deposits or payments made for canceled programs.
The undersigned understands and consents to the above "Participant Agreement & Release" and agrees to participate in any and all activities of C-HOPE programs.