Wellness Agreement Sample Contracts

Parent Partnership and Wellness Agreement
Wellness Agreement • August 26th, 2020

The health and safety of our children and their families along with that of our staff and their families are a top priority. It is important that we partner together to ensure the safety and wellness of all during this time. As parents, we ask that you are diligently monitoring the wellness of your child for their attendance at First Presbyterian Church events and activities (including but not limited to Sunday School, youth group meetings, Bible studies, service / workdays, children’s choir, etc). Please complete the form below with one form per family completed and submitted prior to attending the first activity.

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Wellness Agreement
Wellness Agreement • February 5th, 2020

As a UCAN staff member, I am dedicated to supporting our program participants toward meeting their goals. Along with my colleagues, I am on the front line of service delivery. On a daily basis, many of us, as well as the people we serve, experience trauma such as family violence, gang violence, gun violence, and associated losses.

Wellness Agreement 2013 - 14
Wellness Agreement • March 11th, 2013

The residents of the Shea Hall Wellness floors have selected this form of housing in order to live with residents who have made a similar commitment to a lifestyle free from the influences of alcohol and all illegal or illicit drug use. As a resident of a wellness floor, I hereby agree to make a positive personal commitment to maintain this community expectation. Evidence of this commitment shall be through managing my own behavior and the behavior of my guests as it relates to substance abuse on and off campus.

Parent Partnership and Wellness Agreement
Wellness Agreement • August 10th, 2020

The health and safety of our children and their families along with that of our staff and their families are a top priority. It is important that we partner together to ensure the safety and wellness of all during this time. As parents, we ask that you are diligently monitoring the wellness of your child for their daily attendance of MDO and Preschool. Please complete the form below with one form per family completed and submitted prior to the first day of school. Our staff will also complete the following form for themselves and their family.

Isthmus Wellness Agreement
Wellness Agreement • January 23rd, 2019 • Wisconsin

Thank you for choosing Isthmus Wellness for your care. Rates are available on Isthmus Wellness’ price sheet, or on Isthmus Wellness’ website: http://isthmuswellness.com/services/rates-and-packages/. The following terms and conditions apply to all services received from Isthmus Wellness:

Wellness Agreement
Wellness Agreement • September 15th, 2020

To safeguard the health of all, youth and their parent(s) or guardian(s) must commit to following a set of expectations and norms to minimize the transmission of COVID-19. These standards are the recommendations of medical and public health professionals and meet or exceed federal and state guidelines. All youth who plan to participate in the event outlined in the description of event section must commit to the expectations below.

Contract
Wellness Agreement • April 18th, 2022

This form is to be completed by and signed by an Urgent Counsellor or Indigenous Counselor in collaboration with the student.

Contract
Wellness Agreement • December 8th, 2022

This form is to be completed by and signed by an Urgent Counsellor or Indigenous Counselor in collaboration with the student.

UPG Live Well
Wellness Agreement • February 18th, 2016

This wellness agreement is between the USPM Health & Wellness Advisor and the UPG Employee and outlines the responsibilities and key commitments made by both parties. Any information shared within this relationship is confidential and the advisor representing U.S. Preventive Medicine respects the member’s right to privacy and will maintain records created, stored, accessed, transferred, and/or disposed of following National HIPAA Regulations.

Massage Envy Wellness Agreement
Wellness Agreement • August 6th, 2021

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