By submitting information into the Hark Connector Tool, you, on behalf of yourself or on behalf of a minor of whom you are a parent or legal guardian, acknowledge the veracity of the information that has been or will be submitted, consent to the use and disclosure of the information submitted for the purposes described herein, and agree to reasonably cooperate with Hark in the implementation of the care plan that Hark creates for you or the minor.

You hereby authorize Hark NWA and each of its affiliates (collectively referred to herein as "Hark") to use and disclose the information that has been or will be submitted through the Hark Connector Tool in order to create a care plan for you or the minor and to communicate information about you to agencies and organizations located in the Northwest Arkansas community that have been identified by Hark and listed on your care plan (each, a "Collaborating Agency"). You understand that Hark may use and disclose the information submitted through the Hark Connector Tool, as well as any additional information that Hark may collect from you through correspondence or other conversations, for any reasonable purpose in relation to the care plan, including, but not limited to, the following purposes:

1. Verifying the information submitted through the Hark Connector Tool.

2. Creating a care plan for you with up-to-date community resources.

3. Communicating and sharing information with or among Collaborating Agencies about you or your care plan when necessary.

In providing and assisting with the implementation of your care plan, Hark will comply with the Terms and Conditions and Privacy Policy of Hark. You understand that the Collaborating Agencies are independent third parties that register with Hark to provide community services in various financial, health, and human service areas and are not agents, employees, or representatives of Hark.

You understand that you do not have to agree to this Consent, but that if you do not agree, Hark or the Collaborating Agencies may not be able to provide a care plan or services to you. To the extent you are agreeing to this Consent on behalf of a minor, you certify that you are the parent or legal guardian of the minor who is requesting a care plan or for whom you are requesting a care plan through the Hark Connector Tool and that you have the legal authority to provide the consent requested under this Consent form on behalf of the minor.

Hark welcomes your feedback and suggestions about how to improve Hark's services and Hark Connector, including, without limitation, the feedback and suggestions and all other information, data, material, or other content (collectively, "Submissions"). Such Submissions can be sent to [email protected]. Hark alone (and its licensors, where applicable) will retain all intellectual property rights relating to Submissions, which are hereby assigned to Hark. Further, Hark is free to use any ideas, concepts, methods, know-how, techniques, and processes contained in any Submission for any purpose whatsoever, including, but not limited to, creating and marketing products, information, or services using such information.

Upskill NWA uses the Hark Connector Tool to make referrals to community resources. Your application and other information you submit to Upskill NWA is also stored through the Hark Connector Tool.

Communication Preferences 

The following communication preferences are optional and are not required to receive services from Hark NWA.

Text Messages (SMS)

By providing my mobile number and selecting Yes below, I consent to receive recurring SMS/text messages from Hark NWA related to my request for assistance. Messages may include intake and appointment reminders, resource and referral information, service-plan updates, follow-up questions, client surveys, and other service-related communications. Message frequency varies based on my requests and service activity. Message and data rates may apply. Reply STOP to opt out at any time or HELP for assistance. Consent to receive text messages is voluntary and is not a condition of receiving services from Hark NWA. I may request communication through another available method.

Email

By providing my email address and selecting Yes below, I consent to receive emails from Hark NWA related to my request for assistance. Emails may include intake and appointment reminders, resource and referral information, service-plan updates, follow-up questions, administrative notices, and other service-related communications.

Consent to receive emails is voluntary and is not a condition of receiving services from Hark NWA. I may request communication through another available method.

Please review the information below before making your decision.

The Arkansas State Health Alliance for Records Exchange (SHARE), part of the Arkansas Department of Health, is a secure electronic health information exchange. Healthcare providers use SHARE to securely access health information that helps provide more coordinated care.

Because social determinants of health can significantly impact a person's health and healthcare outcomes, Hark participates in SHARE by making certain limited information available to your authorized treating healthcare providers through the SHARE network.

If you authorize Hark to participate, Hark may share limited information regarding your identified social determinant of health needs and your connections to community resources with SHARE. This information may be accessed by your authorized treating healthcare providers to help coordinate your care.

If you choose not to authorize information sharing:

• Hark will not share your information with SHARE after your decision is recorded.

• Any information previously shared by Hark before your decision may have already been viewed or accessed by your healthcare providers.

• This decision only applies to information maintained by Hark. Other participating healthcare providers may continue to share your information through SHARE unless you contact those providers or SHARE directly.

You may change your SHARE preference at any time by contacting Hark.