New 2 Two Program Consent
Program: I understand that participation in the Soundview Pregnancy Services (SPS) Parenting Program is voluntary. All services are free, confidential and have been either paid for by donors or donated directly by volunteers.
I understand, in the case of needing to cancel or reschedule my coaching appt, it is my responsibility to contact Soundview Pregnancy Services at 631-676-7990 or 516-430-7990 within 24 hours of scheduled appointment.
I understand if there are 3 or more unnotified missed appts I may be reconsidered for my participation in the Parenting Program.
I understand that Material Assistance is an added benefit of active participation in the Parenting Program.
I understand the Amazon Wish list is an opportunity to obtain needed items based on Soundview Pregnancy resources and not a guarantee of such items.
I understand that SPS staff will keep me posted on events and activities related to the Parenting Program. I can also check the website class page for updates to class schedules. I can call 631-676-7990 or 516-430-7990 to request contact with my coach. Most coaches speak to their participants once a week, I understand that I will create a schedule with my coach that works for both of us.
Contact: I understand that SPS values my privacy and makes every effort to safeguard it. I agree to be contacted by Soundview Pregnancy Services (SPS) Staff, which may include Client services, Medical Team, Pregnancy Coach and/or Office staff. I understand that any information obtained is for the purpose of participation in Soundview Parenting Program which may include, coordination of care, providing resources, educating on services provided by Soundview Pregnancy Services and determining appropriate referrals if necessary. I understand that contact may be made by text, phone call, email and if I so choose, in office visits.
Participation in SPS Parenting Program does not constitute a patient physician relationship.
Referrals:SPS provides referrals for my convenience and does not necessarily endorse the materials, policies or practices of these providers/agencies. By accepting referral information, Iunderstand and agree that SPS is in no way responsible for the acts, omissions, results or services of any of the providers/agencies. I am responsible for interviewing and selecting suitable providers/agencies.
Release: I understand that SPS is a faith based non profit organization. I hereby release, waive, discharge and hold harmless Soundview Pregnancy Services (SPS), its successors and/or assigns, together with all its directors, officers, employees and agents, from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my activities with SPS.
I understand that this Release discharges SPS from any liability or claim that I may have against SPS with respect to any bodily injury, personal injury, illness, death, or property damage that may result from my activities with SPS, whether caused by the negligence of the SPS or its officers, directors, employees, agents, invitees or otherwise.