Online Zoom Consent Form/Text
To participate in these zoom events you must agree to the Zoom consent form below.
Alternative Cook, LLC
Agreement for Workshop or One-on-One Consulting
Subject: Workshops or One-on-one Consulting
Facilitator: Jean Elizabeth Duane, Principal, Alternative Cook, LLC
Discussion Site: Virtual Discussion Application (such as Zoom), telephone, or in-person
You will be participating in a virtual (Zoom or a similar type application), telephone, or in-person discussion. The purpose of this discussion is for participant(s) to share scenarios and to understand more about living with gluten sensitivities or food allergies.
Participant shall be defined as a participant in a workshop or someone seeking one-on one-consulting. Dr. Jean Duane is the principal of Alternative Cook, LLC and Jean Duane, LLC. All business is conducted in either of these limited liability corporations.
As a discussion group or one-on-one participant, you may be invited to ask and answer questions, may volunteer to contribute stories and opinions, and may contribute help to other participants to develop strategies to navigate social conundrums. You understand that the discussion will be recorded and may be used in research conducted by Dr. Jean Duane. If used, your name will be replaced with a pseudonym.
Risks or Discomforts
Potential risks and/or discomforts of participation may include minor emotional distress while contemplating the struggles associated with living with dietary restrictions.
You understand that Dr. Jean Duane is a social scientist, a certified chef, and has a masterâ€™s in business administration. She is not a medical doctor or a psychologist and does not represent herself as such. Her engagement with you is limited to navigating social situations, culinary discussions, and business development.
You agree to indemnify and hold harmless Dr. Jean Duane, Alternative Cook, LLC, and Jean Duane, LLC from liability arising from any action or recommendations brought forth in the workshops or one-on-one consulting by Dr. Duane or any other participant. This release extends to all claims of every kind and nature whatsoever, whether known or unknown to the Contractor as well as all his or her surviving family members or their estates.
Possible benefits of participation include providing insight for adults who live the gluten free lifestyle by supplying information on how others cope. Further, the on-going research conducted by Dr. Duane will afford caregivers, cooks, and others a path to empathy by creating an awareness of the plight of everyday life for those with severe food sensitivities.
Consideration to Participate
You will be charged a discussion participation or one-on-one fee, depending on whether you select a workshop or individual consulting. This fee is non-refundable.
Audio and video recordings of the discussion groups will be preserved. Audio portions (protecting visual identities of discussion participants) may be used in a variety of ways including, but not limited to, quotations of participants used in research studies and audios used in an audio-montage. Identity of individuals participating in this study will not be disclosed when information is presented or published. However, should any information contained in the discussions be the subject of a court order or lawful subpoena, Alternative Cook, LLC might not be able to avoid compliance with the order or subpoena. The research information may be shared with federal agencies or local committees who are responsible for protecting research participants, including individuals on behalf of celiac.com.
This Agreement will survive the termination of the participant, Dr. Jean Duane, Alternative Cook. LLC, and Jean Duane, LLC; their survivors and heirs.
This Agreement shall be governed and construed in accordance with the laws of the State of Colorado. The Parties mutually consent to the jurisdiction of the Arapahoe County court for Centennial, CO.
Before you begin, please note that the data you provide may be collected and used by Alternative Cook, LLC. This research is only for US residents over the age of 18 (or 19 in Nebraska). Please be mindful to use a secured Internet connection for your privacy. Your confidentiality will be maintained to the degree permitted by the technology used. Specifically, no guarantees can be made regarding the interception of data sent via the Internet by any third parties.
If you have any questions about this project or your participation, please feel free to ask questions now or contact Dr. Jean Duane here
By checking the box below you are consenting to this agreement and you digitially signing this document