Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Compensation *

As a contractor, I understand that I will receive financial compensation from Paradise Fields. You will be provided with full meals and accommodations during the program.

Yes

Alignment with Seventh-day Adventist Church *

I understand that this is a program implemented by Seventh-day Adventists to support the mission of the worldwide Seventh-day Adventist church. I agree to not share with patients/guests ideas or beliefs that are not aligned with the 28 fundamental beliefs of the Seventh-day Adventist church.

Yes

Alignment with Adventist health message and lifestyle medicine *

I understand that this program aligns with the health principles of the Seventh-day Adventist church and lifestyle medicine, including a plant-based diet and abstinence from alcohol, caffeine and tobacco. The program also does not support health practices based on mystical or energy systems, including yoga, reiki, homeopathy, and eastern meditation/medicine. I agree to refrain from sharing or promoting to patients/guests information that do not align with with the health principles outlined here.

Yes

I agree to abide by the following dress code. I understand that the intention of this dress code is to be professional, represent Christ in our appearance and minimize distractions. *

* No jewellery is permitted, including but not limited to ear rings, necklaces, bracelets or piercings of any kind. Wedding rings/bands are permitted. * No form fitting clothing (including yoga pants, muscle shirts) or revealing clothes (including see-through clothes that show underwear/lingerie, short shorts, short skirts) are permitted. * Healthcare providers are expected to wear their typical uniform (ex. scrubs). All other volunteers/staff must wear the program t-shirt/uniform during program hours/sessions. * All staff and volunteers must use their best judgment to respect Christian principles of simplicity, modesty and professionalism in their attire. * Violations of the dress code will lead to a warning followed by dismissal for repeat violations.

Yes

Respect and integrity *

I agree to treat all staff, volunteers and especially patients/guests with Christlike kindness, modesty and respect. I understand that any acts of harrassment or improriety, whether verbal, physical or sexual, will lead to immediate dismissal from the program.

Yes

Faithfulness, leadership and patient care *

I agree to respect program leadership from Paradise Fields and Lifestyle Is Medicine, my department leader and serve with faithfulness in my assigned role. I understand that this is a clinical program and as such, that the medical and naturopathic doctors have ultimate responsibility for the care of patients/guests. I will therefore respect their directions with respect to the care of patients/guests nor contradict the information they share with patients/guests.

Yes

Medical advice and health topics *

If I am a non-clinical team member, I understand that I am not authorized to share medical advice and agree not to share medical advice to patients/guests. I agree to refrain from sharing health information that contradicts those provided by the healthcare team and will refer any health-related questions to the appropriate healthcare provider (e.g. medical question to the doctors, nutrition questions to the nutritionist etc). I will refrain from discussing controversial health topics with patients/guests.

Yes

Patient info confidentiality *

Patient records and information are strictly confidential. I agree to never discuss any patient's health information with others except for with staff health care providers within the clinical setting of the immersion.

Yes

Safety and Feedback *

I understand that as a valued member of the team, I am entitled to be treated with respect by all staff and leadership and provided a safe environment to serve. I understand that I will be provided with a complaints/feedback mechanism to voice concerns and feedback.

Yes

Photos/videos *

I understand that photos and videos will be taken during public components of the program and that I may appear in such photos/videos. I agree to appear in such photos/videos and permit Paradise Fields, Lifestyle Is Medicine, Not By Bread Alone and other program partners to share such photos/video publicly, including on websites and social media, and in the production of other multimedia content (e.g. promotional video) and for future marketing.

Yes

No

I understand that this agreement is binding over the full duration of the program. I understand that violations of any component of this agreement will lead to dismissal. *

Yes