Information Consent:
I, {name}, agree that any and all information provided on the application/form is accurate and true. In addition to the accuracy and truthfulness of the information provided, I agree that the information may be shared with any parties that Cape Assist deems necessary for funding and reporting purposes. I acknowledge that Cape Assist will never use or sell any of my information for any purposes outside of the scope of the program or the organization's mission of focus and will take the necessary measures and protocols to protect any information provided.
Program Confidentiality:
I, {name}, understand that any information discussed in the program is strictly confidential. I acknowledge that all participants of the program are expected to keep all discussions during the program confidential in order to protect all participants and the integrity of the program. Cape Assist may reserve the right to break any confidential agreement in the case of an event where a participant presents a threat to themselves or others.
Attendance Policy:
Participants of the program MUST attend all sessions of the program in order to complete the program and to receive any incentive(s) from the program. Participants who receive an incentive(s) prior to the end of the program and fail to uphold the attendance policy, may be asked to return any incentive(s), or such incentive(s) may be canceled without notice of the participant. If a participant should find themselves unable to attend a session, the participant must contact Cape Assist at (609) 522-5960 or reach out directly to the program facilitator. Cape Assist reserves the right to make exceptions to the attendance policy.
Media Consent:
I, {name}, acknowledge that if I agree and consent to the "media consent" that my name, photo, age, likeness, appearance, image, voice, video, quote, and artwork may be used for promotional, advertising, and educational material including but not limited to print, digital, direct mail, and for use on the internet for an indefinite duration. I acknowledge that this consent will also cover any virtual sessions conducted through video conferencing such as Zoom or any other video and/or phone conferencing platform that Cape Assist may utilize as part of the program. The facilitator(s) of the program will give prior notice before initiating any photo capturing and/or recordings at which point, any participant can object and request to be exempt from it.
Termination of Agreement & Consent:
I, {name}, acknowledge, and agree that this agreement and consent will be binding and effective immediately upon completion. The agreement and consent will remain effective until either party revokes or terminates the agreement. Termination of agreement and consent can be made in writing and sent to Cape Assist at 3819 New Jersey Avenue, Wildwood, NJ 08260, or by email at info@capeassist.org. Termination of agreement and consent can also be made by contacting the program facilitator directly.