Please be informed that this method may not be a confidential means of communication. If you choose to use this method of communication with Camp Triumph administrators or the Triumph Center in general, there is a chance that a third party may be able to intercept these messages.
CONSENT FOR TRANSMISSION OF PROTECTED HEALTH INFORMATION BY NON-SECURE MEANS
I consent to allow Camp Triumph administrators and necessary office staff to use unsecured email to transmit to me and exchange the following protected health information:
- Information related to Camp Triumph application, registration, and participation, including application acceptance status.
- Information related to Camp Triumph activities, special events, and other important announcements and updates.
- Information related to billing and payment.
I have been informed of the risks of transmitting my protected health information by unsecured email. As you are aware of these risks, the Triumph Center cannot be held responsible for any risks to protected health information that you knowingly choose to communicate with agency staff via unsecured email. I understand that I am not required to sign this agreement in order to participate in camp programing. I also understand that I may terminate this consent at any time by giving written notice to the Camp Triumph Director or the Triumph Center office.