Information Consent:
I, {participantsName}, agree that any and all information provided on the application/form for the Strengthening Families Program conducted by Cape Assist 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 my information for any purposes outside the program's scope or the organization's mission of focus and that Cape Assist will take the necessary measures and protocols to protect any information provided.
Program Confidentiality:
I, {participantsName}, understand that any information discussed in the program is strictly confidential. I acknowledge that all program participants are expected to keep all discussions during the program confidential to protect all participants and the program's integrity. 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/Program Requirements:
Participants of the program MUST attend all program sessions and complete the required program forms and tests to successfully complete the program and receive any incentive(s) from the program. Participants who receive any incentive(s) during and/or after the program has ended and fails to uphold the attendance policy and/or complete the program requirements, such as the Program Form, Pre/Post-Tests, and any other required program document the facilitator deems necessary, may be asked to return any incentive(s), or such incentive(s) may be canceled without notice to 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 or program requirements.
Media Consent:
I, {participantsName}, agree and have consent for all the participants listed on this form that their names, photos, ages/grades, attending schools, likenesses, appearances, images, voices, videos, 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 without compensation. 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. In addition, I agree that I am responsible for removing any person(s) I do not have media consent and/or are not listed on this form. The facilitator(s) of the program will give prior notice before initiating any photo capturing and/or recordings. At this point, any participant can object and request to be exempt.
Termination of Agreement & Consent:
I, {participantsName}, 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.