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Consent Form

Consent form to participate in services offered by B2B Cincinnati

Step 1 of 7

Consent Form

I know what Back2Back Cincinnati is providing to me, to my student and/or my family. I give permission for the following family members to participate in Back2Back Cincinnati activities. I understand this includes but is not limited to coaching, educational guidance, therapeutic support, group activities, and care coordination. I understand Back2Back Cincinnati will store all personal information and program documents in a confidential manner. I understand myself and/or my student will go on outings with Back2Back Cincinnati, and I give permission for myself and/or my student to be transported to and from these outings in Back2Back staff members’ personal vehicles.
Power School(Required)
If my student is reaching educational support, I give permission to Back2Back Cincinnati to access my student’s Power School.
Coaching Communication(Required)
I give permission for my student to communicate with their coach via Facebook Messenger for mentorship purposes.
Contacting Student(s)(Required)
I give permission for Back2Back Cincinnati staff to contact my student via text messages and phone calls.