PURPOSE

This Applicant Waiver and Acknowledgement Agreement (the “Agreement”) outlines the terms and conditions of applying for financial assistance through Connect Fund, a not-for-profit program supporting healthcare-related costs for 2SLGBTQI+ individuals.

By submitting an application to Connect Fund, you acknowledge and agree to the following:

1. NO GUARANTEE OF FUNDING

1. Submitting an application does not guarantee financial assistance.
2. Funding decisions are based on available resources, eligibility criteria, and assessment by our program.
3. We reserve the right to decline applications without providing specific reasons.

2. FUNDING DISBURSEMENT

1. Approved funding will be disbursed directly to the applicable service provider and not directly to the applicant.
2. Maximum funding amounts are subject to program guidelines and available resources and are at the sole determination of Connect Fund.
3. Connect Fund will endeavour to communicate its funding decision to each applicant in a timely manner after determining same.
4. We may cancel any previously approved funding at anytime for any reason at our sole discretion.

3. INFORMATION REQUIREMENTS

1. You affirm that all information provided in your application is accurate and truthful to the best of your knowledge.
2. If we determine that false or misleading information was provided, we reserve the right to deny your application, cancel any previously approved funding, and request repayment of funds disbursed due to misrepresentation.

4. MEDICAL SERVICES AND LIABILITY WAIVER

4.1 SCOPE OF CONNECT FUND'S ROLE

Connect Fund's role is strictly limited to providing financial assistance for approved healthcare and related services (the “Provided Services”). You acknowledge and agree that Connect Fund:

1. Does not provide medical services, treatments, or healthcare of any kind;
2. Does not make medical recommendations or provide medical advice;
3. Does not evaluate, endorse, or guarantee the quality of any Provided Services; and
4. Does not maintain any control over, or responsibility for, the delivery of any Provided Services.

4.2 COMPLETE RELEASE AND WAIVER OF LIABILITY

You hereby fully release, waive, discharge, and covenant not to sue Connect Fund and its directors, officers, employees, volunteers, agents, representatives, successors, and assigns (collectively, the "Released Parties") from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to:

1. Any loss, damage, injury, or death that may be sustained by you in connection with the Provided Services obtained using Connect Fund's financial assistance or otherwise;
2. Any acts, omissions, negligence, or misconduct of any healthcare or other service provider you select;
3. Any complications, side effects, or unexpected outcomes from medical or other treatments or procedures related to the Provided Services;
4. Any decisions made by healthcare or other service providers regarding your care or treatment;
5. The quality, appropriateness, or efficacy of any medical or other services received; and
6. Any breach of confidentiality or privacy by any healthcare or other service provider(s).

4.3 HEALTHCARE PROVIDER SELECTION AND VERIFICATION

You acknowledge and agree that:

1. You are solely responsible for:
   1. Selecting your healthcare and other service providers;
   2. verifying their credentials, qualifications, and licensing status;
   3. Making informed decisions about your medical care and treatment options;
   4. Understanding the risks and benefits of any procedures or treatments; and
   5. Obtaining all necessary information about your medical care and any other services that you receive.
2. Any list of healthcare or other service providers that may be provided by Connect Fund:
   1. Is for informational purposes only;
   2. Does not constitute an endorsement or recommendation;
   3. Does not guarantee availability, quality, or suitability of services; and
   4. Should not be relied upon as the sole basis for selecting a healthcare or other service provider.

4.4 INDEPENDENT MEDICAL JUDGMENT

You acknowledge that:

1. All medical decisions are made independently by you and your chosen healthcare and/or other service providers;
2. Connect Fund does not influence or participate in medical decision-making;
3. Approval of funding does not constitute medical advice or endorsement of any particular treatment plan; and
4. You should seek independent medical advice as appropriate for your circumstances.

4.5 ASSUMPTION OF RISK

You expressly agree that your use of Connect Fund's financial assistance and any subsequent medical or other services is undertaken at your own risk. You assume full responsibility for all risks, both known and unknown, connected with or arising from such services.

4.6 INDEMNIFICATION

You agree to indemnify, defend, and hold harmless the Released Parties from and against any and all claims, losses, damages, liabilities, costs, and expenses (including reasonable legal fees) arising from or related to your use of (i) Connect Fund's financial assistance; (ii) any medical services; or (iii) any other services, obtained therewith.

5. PROGRAM DISCRETION AND POLICY CHANGES

Connect Fund operates under the direction of our board and operations may be modified, suspended, or terminated at any time based on funding availability or organizational decisions. Any changes to program policies will be communicated as appropriate, but it is your responsibility to stay informed about program requirements.

6. PRIVACY AND CONFIDENTIALITY

6.1 PRIVACY PROTECTION

We respect your privacy and will keep your application responses confidential to the extent permitted by law. Connect Fund complies with the Personal Information Protection and Electronic Documents Act (PIPEDA) and applicable provincial privacy legislation.

6.2 HEALTHCARE PROVIDER INFORMATION SHARING

You acknowledge and consent that Connect Fund may share your personal information with approved healthcare and related service providers ("Service Providers") for the following purposes:

1. Verifying appointment bookings and service delivery;
2. Processing payments for approved services;
3. Confirming service eligibility and scheduling;
4. Coordinating care delivery when multiple providers are involved; and
5. Addressing any quality-of-care concerns or funding disputes.

Such information sharing shall be limited to:

1. Your name and contact information;
2. The specific services approved for funding;
3. The approved funding amount;
4. Appointment scheduling details; and
5. Any relevant health or safety accommodations required for service delivery.

6.3 DATA COLLECTION AND PROCESSING

By signing this Agreement, you explicitly consent to:

1. The collection and processing of your personal information by Connect Fund, including:
   1. Contact and demographic information;
   2. Financial information necessary to assess funding eligibility;
   3. Basic health information related to requested services; and
   4. Information about your support needs and circumstances;
   5. The electronic storage of your information in Connect Fund's secure database systems;
2. The analysis of de-identified aggregate data for program evaluation and reporting purposes;
3. The retention of your personal information for a period of up to 7 years from your last interaction with Connect Fund;
4. The use of your contact information to:
   1. Process your funding application;
   2. Communicate decisions about your application;
   3. Coordinate approved services with Service Providers;
   4. Send essential program updates or policy changes;
   5. Request feedback about your experience with funded services; and
5. The disclosure of your information as required by law or court order, or to protect the rights, property, or safety of Connect Fund, its staff, or others.

You may withdraw your consent at any time by written notice to Connect Fund, provided that such withdrawal shall not affect the lawfulness of processing based on consent before its withdrawal. Withdrawal of consent may affect our ability to provide funding or coordinate Provided Services on your behalf.

7. GOVERNING LAW AND JURISDICTION

This Agreement shall be governed by and construed in accordance with the laws of Ontario and the federal laws of Canada applicable therein. The parties irrevocably submit to the exclusive jurisdiction of the courts of Ontario.

8. SEVERABILITY

If any provision of this Agreement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Note: After signing the waiver, you will be directed to the application instructions page.

Please note that once you click the Submit button, you will be redirected to the application form for your selected service.