Consent for the Release of Confidential Information

I understand that all Offender Education Programs shall abide by and obtain any consent to disclosure required by applicable Federal and State laws regarding confidentiality of patient/client records including, as applicable and without limitation, 42 United States Code §290dd-2; 42 Code of Federal Regulations, Part 2, and Health and Safety Code, Chapter 611. I understand my records cannot be disclosed without my written consent unless otherwise provided for by the regulations. I also understand that I may revoke this consent in writing at any time except to the extent that action has been taken in response to it, and that in any event, this consent expires automatically as follows.

DWI EDUCATION OF SOUTHEAST TEXAS

Class Rules and Policies

  1. Students must not have had any alcoholic beverage or be under the influence of any drug prior to attending class. If found to be under the influence of drugs and/or alcohol, instructor reserves the right to terminate your participation in program and you will forfeit all fees paid.
  2. Full payment is due prior to the beginning of the class.
  3. Late arrivals will not be admitted to class and will forfeit fee. Participant will have a choice to reschedule in another class and full payment will be required.
  4. No missed sessions are allowed. If participant misses a session, then he/she will have to start again in a different course, beginning with session one. No refunds or make-up sessions are offered due to missed sessions.
  5. Each participant will be administered a test and a score of 70 or higher must be obtained to receive a certificate of completion.
  6. On the last day of class, after all sessions and test are completed, each participant must participate in an exit interview to receive credit for the class.
  7. Children and relatives are not permitted in the class or office while class is in session.
  8. Classroom is a tobacco-free environment. No chewing tobacco, vapes, or e-cigs during class.
  9. Due to confidentiality, no taking pictures or videos during class. No recordings of any kind.
  10. Disruptive individuals will be asked to leave and will be unsuccessfully discharged. Fee will be forfeited.
  11. Please be respectful of others.
  12. Participation is mandatory in order to receive a certificate.
  13. Participants must complete all assignments and turn them in to the instructor when requested.
  14. Turn all electronic devices and cell phones on silent or off.
  15. A $20.00 fee for a replacement certificate.
  16. NO REFUNDS, NO EXCEPTIONS.

 

PARTICIPANT ACKNOWLEDGEMENT

I have read the above class rules and policies for the DWI Education Program. My signature signifies my agreement to follow above rules 1-16.