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HiRR Consent Form

HiRR ADULT (16+) CONSENT:

Required for HiRR Adults (16+) Prior to Program Participation

Please complete the following online consent form agreeing to your rights and responsibilities of participating in HiRR Co as a patron,

and the safety limitations of such rights. 

HiRR Program Required
Right to Privacy (By checking the box below, I understand that HiRR Company will respect my right to privacy by keeping all of my identifying information safe and secure, private and confidential. ) Required
Responsibility to Respect (By checking the box below, I confirm that I have reviewed the online Group Values, Netiquette Guidelines, and Program Fees. I agree that I will be a responsible patron of HiRR by respecting the program guidelines and all people involved with HiRR Co, participating appropriately, and keeping the confidence of other patrons.) Required
Limits to Privacy (By checking the box below, I acknowledge the limits to my privacy at HiRR Co. I understand that if it is assessed that I am a risk to myself, someone else, or any child under 16 yrs of age is being harmed or at risk of any harm, that privacy becomes secondary to safety at all times and appropriate referrals and supports will be put in place. ) Required

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HiRR PARENTAL (<16) CONSENT:

Required for HiRR Parents/Guardians for Under 16 yrs of age

Please complete the following online consent form providing permission for your TEEN to participate in HiRR Co Programs, and agreement to  the confidentiality and it's limits.

HiRR Program Required
Right to Privacy (By checking the box below, I understand that HiRR Company will respect my right to privacy by keeping all of my identifying information safe and secure, private and confidential. ) Required
Responsibility to Respect (By checking the box below, I confirm that I have reviewed the online Group Values, Netiquette Guidelines, and Program Fees. I agree that I will be a responsible patron of HiRR by respecting the program guidelines and all people involved with HiRR Co, participating appropriately, and keeping the confidence of other patrons.) Required
Limits to Privacy (By checking the box below, I acknowledge the limits to my privacy at HiRR Co. I understand that if it is assessed that I am a risk to myself, someone else, or any child under 16 yrs of age is being harmed or at risk of any harm, that privacy becomes secondary to safety at all times and appropriate referrals and supports will be put in place. ) Required

Thanks for submitting!

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