Informed Consent and Policies
Please read and sign below. If you have any questions, please feel free to ask before signing.
Confidentiality Policy
Confidentiality means that the mentor is responsible to you for safeguarding information obtained during each session. All information about your session is kept confidential.
Mentees will have a file created in their name(s). The purpose of that file is to help the mentor remember relevant information and carry out his/her responsibilities effectively and efficiently. Files will be maintained throughout the mentoring relationship. At the close of the mentoring relationship, files will be shredded.
Fees and Payment
The fees for a mentoring session at Sparrow Mentoring, LLC are __________.
The mentees' signatures on this document indicate that they consent to Sparrow Mentoring, LLC charging the credit card they have on file with Sparrow for services rendered. If their credit card changes for any reason, it is their responsibility to notify Sparrow of the change.
Cancelation Policy
Mentees who need to cancel individual mentoring appointments are requested to do so at least 24 hours in advance. A session charge will be accrued if a mentee does not attend an appointment or provide at least a 24-hour notice of cancellation. Being late for an appointment by 15 minutes or more may require rescheduling and result in a session charge. The mentee’s signature below indicates they consent to charging the credit card on file with Sparrow Mentoring, LLC for any missed sessions and corresponding fees. The mentor may also terminate the mentor relationship if the mentee has missed three appointments without giving a sufficient 24-hour notice. Appointments can be canceled by calling (317) 207-6267 and leaving a voicemail. If, for some reason, your mentor must cancel an appointment, they will call the phone number you have provided and, if you are not there, will leave a message.
Contacting after hours
You may leave a voicemail for your mentor at (317) 207-6267. Additionally, you may contact your mentor via their business email. We will make every effort to contact you within 2 business days using the contact information provided, unless unforeseen circumstances arise.
Acknowledgment and Consent
By submitting this form, you are indicating that you have read and understand this document, that any questions you have about this document were answered to your satisfaction, that you willingly consent to the mentoring sessions, and that you were offered a copy.