|
|
|
|
| | |
|
|
PLEASE NOTE: This registration includes BOTH Family Information and Student Information. We recognize that some questions may feel repetitive, and we appreciate your patience. Our system also supports youth program enrollment at The Center, which is why these sections appear in this format. When "Adding New Student", simply enter the information for yourself as you will be receiving access to the classes and resources.
Ages 18 and above
|
|
Event: |
|
|
Start Date/Time: |
End Date/Time:
|
|
Fee per Student:
|
Room:
|
|
* - denotes required fields |
|
Family Information |
|
|
|
| | | |
| | | |
|
Students entered below will be added to your family's account
|
|
Add New Student #1:
(Show-Hide Details)
|
|
Add New Student #2:
(Show-Hide Details)
|
|
Add New Student #3:
(Show-Hide Details)
|
|
Add New Student #4:
(Show-Hide Details)
|
|
Add New Student #5:
(Show-Hide Details)
|
| | | |
|
Questions/Options: |
|
|
| |
| | | |
|
Additional Information: |
|
| | | |
|
General Liability Waiver & Release of Claims
(Show-Hide Details)
I understand that participation in The Hive – Cancer Support & Wellness Program involves physical, emotional, and environmental risks. I voluntarily assume all risks associated with participation and release Combat Ministries, Inc., its staff, volunteers, independent contractors, and partner organizations from any and all liability for injury, loss, or damages arising from my participation.
I've read the above and agree.
|
|
|
Medical & Wellness Services Consent
(Show-Hide Details)
I understand that wellness services offered through The Hive—including massage, chiropractic care, physical therapy, cupping, stretching, movement classes, and nutrition support—are provided by licensed or certified independent contractors.
I acknowledge:
These services are supportive and not a substitute for medical treatment
I am responsible for communicating any medical conditions or limitations
I may decline or stop any service at any time.
I've read the above and agree.
|
|
|
Mental Health Services Disclosure & Scope of Practice
(Show-Hide Details)
I understand that counseling services are provided by Haven Counseling, LLC or other independent licensed providers.
I acknowledge:
These providers are not employees of Combat Ministries
Counseling is not a crisis service
Confidentiality has legal limits (harm to self/others, abuse, court orders, etc.).
I've read the above and agree.
|
|
|
Independent Contractor Acknowledgment
(Show-Hide Details)
I understand that all wellness and counseling providers at The Hive operate as independent contractors, not employees of Combat Ministries. Combat Ministries is not responsible for the professional decisions, actions, or omissions of these providers.
I've read the above and agree.
|
|
|
Media & Photography Release
(Show-Hide Details)
I give permission for photos/videos of me to be used for program promotion, reporting, and storytelling, on a case-by-case basis.
I've read the above and agree.
|
|
|
Childcare Waiver & Emergency Consent
(Show-Hide Details)
I understand that onsite childcare provided by Combat Ministries is not licensed daycare. I release Combat Ministries, its staff, and volunteers from liability for injuries or incidents that occur during childcare. I give permission for basic first aid to be administered and for emergency medical care to be sought if necessary.
I've read the above and agree.
|
|
|
Confidentiality & Community Conduct Agreement
(Show-Hide Details)
I agree to:
Maintain confidentiality of all group discussions
Treat all participants, staff, and volunteers with respect
Follow safety guidelines and staff instructions
Refrain from harassment, discrimination, or disruptive behavior.
I've read the above and agree.
|
|
|
Informed Consent for Participation in Group Activities
(Show-Hide Details)
I understand that group activities may include movement, creative work, discussion, or emotional processing. I may opt out at any time.
I've read the above and agree.
|
|
|
Data Use & Privacy Agreement
(Show-Hide Details)
I understand that Combat Ministries collects personal and health-related information solely for program support, safety, and reporting. My information will not be sold or shared outside of essential program operations.
I've read the above and agree.
|
|
|
HIPAA Acknowledgment of Understanding
(Show-Hide Details)
Combat Ministries, Inc. and The Hive – Cancer Support & Wellness Program are not HIPAA-covered entities. However, we are committed to protecting your privacy and safeguarding sensitive health information.
I acknowledge that:
1. My health information will be kept confidential and used only for program support, safety, and coordination of services.
2. Independent licensed providers (e.g., counselors, PTs, chiropractors) may be HIPAA-covered entities and will maintain their own HIPAA-compliant records
Combat Ministries does not access or store clinical treatment records from independent providers.
3. I may request to review or update the personal information I provide to the program.
I've read the above and agree.
|
|
| | | |
|
Other Questions/Comments: |
|
| | | |
|
Please Wait...
|
|
| |