BWAZ Mental Health Support Group (Payment Plan) Onboarding Form

• ATTENDANCE/PARTICIPATION POLICY:
  BWAZ and the Program Facilitator will make all efforts to ensure the attendance and/or participation of all attendees for each meeting by providing reminders via chat and email. However, neither BWAZ nor the Program Facilitator can guarantee the attendance and/or participation of all attendees during this program. The Program Facilitator will be present for all meetings, regardless of the number of those in attendance. By signing up for this program, you agree and understand that group attendance and/or participation cannot be guaranteed.
• CANCELLATION/RESCHEDULING POLICY: 
  All attendees will be provided a total of eight (8) weekly meetings during this program for 90 minutes each meeting. In the rare case when BWAZ and/or the facilitator have to cancel a meeting for any reason, the end date of this program will be extended by an additional week to ensure that attendees receive a total of eight (8) meetings.
• PAYMENT/REFUND POLICY:
  Payments for this program are processed by BWA Black Women of Arizona BWAZ, LLC. All payments are non-refundable. No exceptions. Attendees who sign up for this program using a payment plan understand that the second payment will automatically be drafted fourteen days from the first payment on the same payment method used for their initial payment. You hereby agree that you are an authorized user of the payment method used to pay for this program. You understand and agree to the terms and conditions of this program as outlined in this document. You understand that any payment dispute made by you and/or your banking institution in regard to the payment(s) for this program is subject to legal action to the fullest extent of the law.
• LATE ARRIVALS:
  BWAZ does not charge any fees for late arrivals to meetings, however, attendees are billed for the entire meeting time even if they arrive late to the scheduled meetings.
• ONE-ON-ONE MEETINGS:
  This is a group program that may contain up to ten (10) attendees. For attendees who are interested in working with the Program Facilitator individually, please contact them directly for more information. Please note that previous payments made for this program may or may not be eligible for transfer as a credit to work with the Program Facilitator individually as this decision is at the full discretion of the Program Facilitator. 
• REVIEWS/FEEDBACK:
  Reviews and/or feedback shared by attendees regarding their overall experience with this program may be shared with the public for marketing purposes. All feedback received by attendees will remain anonymous.
• LEGAL DISCLAIMER:
  All information provided in this program is for informational/educational purposes only. None of the information provided in this program is considered medical advice and should not be used as a substitute for seeking medical advice from a licensed medical professional. Although privacy is our top priority for all attendees, no therapist-client relationship will be formed by joining this program. [Beyond This Moment Life Coaching and Business Consulting, LLC] will not provide any medical diagnoses during this program. [Beyond This Moment Life Coaching and Business Consulting, LLC] cannot complete any medical documentation for attendees of this program. This includes, but is not limited to, FMLA documentation, short-term disability, long-term disability, workplace accommodations, or housing accommodations documentation. Insurance cannot be used to pay for this program. Neither BWAZ nor the Program Facilitator can provide documentation to be submitted to your insurance provider for reimbursement.

I have read, understand, and agree to all of the above terms and conditions.

• OUT-OF-STATE ATTENDEES:
  Please note that meeting times will be based on Arizona Mountain Standard Time.
• VIRTUAL MEETING SPACES:
  This program will take place virtually using Zoom and Slack. Meetings will be conducted via Zoom Video Conferencing. You should be in a quiet, private area away from distractions during meeting times. The private chat community for this program will be available on Slack. Once registered, you will receive the direct link for the Zoom meetings and an email invite to the Slack platform.
• OUR COMMITMENT TO YOUR PRIVACY:
  The information discussed during the meetings and in the private chat community is limited to attendees, BWAZ, and the Program Facilitator only. None of the information discussed during your time in this program will be shared with third parties. This includes, but is not limited to, friends, spouses, employer(s), etc.
• Attendees are not permitted to share information discussed in this program by other attendees with anyone outside of this program. This includes, but is not limited to, recording meetings on a personal device, forwarding information to others outside of this program, or taking screenshots of the meetings and/or private chat community. Failure to abide by this guideline will result in immediate removal from the entire program and all previous payments made will be forfeited. No exceptions.
• MEETING TIMES:
  Meeting times for this program will be on a weekly basis at the same time each week with each meeting lasting approximately 90MIN. This program is eight (8) weeks long and will include a total of eight (8) meetings. [ Tuesdays from 6:00PM-7:30PM MST. ]
• MEETING REMINDERS/ATTENDANCE POLICY:
  BWAZ may contact attendees via email and/or chat to remind them of upcoming meetings, but this is not a guaranteed service. Attendees are responsible for making sure that they are present for all meetings. Unless the meetings are canceled by BWAZ and/or the Program Facilitator, any meetings missed by attendees will be forfeited. No exceptions.

E-SIGN DISCLOSURE

Your electronic signature signifies your agreement to transact business electronically, which includes receiving all documents in HTML and/or PDF format and communicating over the Internet.

You also certify that you are at least 18 years of age and have access to the Internet to receive correspondence from BWAZ and to view, print, and retain all documentation.

You may withdraw your consent to electronically transact business with BWAZ by emailing BWAZ at info@blackwomenofarizona.com. By doing so, BWAZ will no longer be able to provide you with access to the BWAZ Mental Health Support Group.

I acknowledge that I have received and agree to these terms.

SIGNATURE

I have received and have had the opportunity to review the terms and conditions of the BWAZ Mental Health Support Group service and I agree to all of its terms and conditions.

By providing your electronic signature you are engaging with BWAZ to conduct business and you agree to the following:

You hereby certify that you are an authorized user for the payment method provided to pay BWAZ for this service. You authorize BWAZ to use the payment method provided by you to charge the fee for this service. By signing below, you certify that all charges from BWAZ are valid.

You acknowledge that you have received and agree to the terms of BWAZ’s E-Sign Agreement and that you have received and have had the opportunity to review the refund and cancellation policy.

You acknowledge that you have received the terms and conditions of the BWAZ Mental Health Support Group service, and agree to all of its terms and conditions.