Telegroup Guidelines and Agreement (ENG/SPANISH)

Telegroup Guidelines and Agreement
This form must be completed by each participant prior to each tele-group or class you attend offered by Richstone Family Center.
Name
First NameLast Name
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
For the safety and privacy of all tele-group and class participants, please carefully read and agree to the following guidelines. Violation of these guidelines will result in immediate removal from the tele-group.
No driving or traveling during a tele-group session. Participants must stay in one location for the duration of the tele-group.
I agree and understand (initial)
Clear
Estoy de acuerdo y entiendo (inicial)
No drinking alcoholic beverages or consumption of cannabis or taking drugs during a tele-group session.
I agree and understand (initial)
Clear
Estoy de acuerdo y entiendo (inicial)
No recording or taking screen shots.
I agree and understand (initial)
Clear
Estoy de acuerdo y entiendo (inicial)
I understand that I will need to verify that I am in a confidential location at the start of each tele-group session.
I agree and understand (initial)
Clear
Estoy de acuerdo y entiendo (inicial)
I understand and confirm that there are no other children or adults in the room with me during the tele-group session. (Headsets are recommended)
I agree and understand (initial)
Clear
Estoy de acuerdo y entiendo (inicial)
I understand that the group/class will be closed 5 minutes after the start time. I agree to be on time.
I agree and understand (initial)
Clear
Estoy de acuerdo y entiendo (inicial)
Which class/group are you taking?
Signature/Firma
Clear
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: