Version: August 22, 2026 · To be completed securely before paid service begins
Do not email a completed copy through ordinary email if it contains sensitive personal information. Shepherd will arrange an appropriate signing and storage method. This public page is a template; it becomes part of the agreement only when completed and accepted with a Service Order.
A. Participant and service information
Participant legal name: ______________________________________________
Preferred name: _____________________________________________________
Date of birth / age confirmation: _____________________________________
Province of residence: _______________________________________________
Service Order date or reference: ______________________________________
Primary communication method: _______________________________________
B. My understanding of Shepherd
By initialling or checking each statement, I confirm that it has been explained in a way I understand:
I am at least 20 years old, am participating voluntarily and can provide informed consent.
Shepherd provides structured, non-clinical companionship and community connection.
Shepherd is not psychotherapy, counselling, health care, home care, transportation, crisis intervention, emergency response or 24/7 monitoring.
I will call 9-1-1 for immediate danger or urgent medical help, and may call or text 9-8-8 for suicide crisis support in Canada.
Messages to Shepherd may not be seen promptly and must not be used as an emergency channel.
No particular emotional, social, relationship, community or health outcome is guaranteed.
Paid companionship may involve genuine care, but does not guarantee friendship, indefinite service or contact after service ends.
C. Required operational consent
I consent to Shepherd collecting, using and retaining the minimum personal information reasonably necessary to assess fit, schedule and provide companionship, administer payment, document my consent choices, respond to complaints or material safety incidents, and meet legal obligations.
I consent to the required operational processing described above and in the Privacy Policy.
I understand that I may withdraw consent on reasonable notice, but Shepherd may be unable to continue service and may retain records required for legal, payment, safety or evidentiary purposes.
D. Recording and notes
Shepherd sessions are not audio- or video-recorded. Shepherd does not keep detailed conversation transcripts or clinical-style session notes. Limited records may document scheduling, attendance, consent, authorized sharing, payment, material boundary or safety incidents, complaints and legal requirements.
I understand and acknowledge this records practice.
E. Communication platform consent
Proposed voice/video platform(s): __________________________________________
Proposed messaging channel(s): ____________________________________________
I agree to use the listed platforms and understand that internet, telephone, email, text and video services carry privacy and security risks that cannot be eliminated.
I will not use ordinary email or messaging to send detailed medical records, passwords, payment-card numbers or urgent crisis information.
F. Optional information sharing
This section is optional. Declining it does not prevent companionship. Payment or referral does not create permission.
I authorize Shepherd to share the categories checked below with:
Authorized person / organization: ________________________________________
Relationship and contact method: _________________________________________
Scheduling and attendance information
A high-level statement about whether companionship is continuing or being reviewed
General community-connection goals that I specifically approve
A material safety or boundary incident, limited to what is reasonably necessary
Other specific information: __________________________________________
Not included unless separately and specifically authorized: detailed conversation content, personal opinions, sensitive personal disclosures or information unrelated to the stated purpose.
Purpose of sharing: _____________________________________________________
This authorization expires on: ____________________ or when service ends, whichever occurs first.
I understand that I may change or withdraw this authorization by contacting Shepherd. Withdrawal applies prospectively and cannot reverse a disclosure already lawfully made.
G. Optional emergency contact
Emergency contact name: ________________________________________________
Relationship: __________________________ Phone: __________________________
I authorize Shepherd to contact this person and disclose limited information if Shepherd reasonably believes there may be an immediate and serious threat to life or safety, or if I separately ask Shepherd to do so.
I understand that this person is not automatically authorized to receive routine updates or conversation content.
Relevant communication or accessibility information strictly necessary for an urgent contact (do not provide a medical history):
______________________________________________________________________
H. Emergency and legally permitted disclosures
I understand that confidentiality is not absolute. Shepherd may contact 9-1-1, an appropriate emergency service or my authorized emergency contact and may disclose limited information where applicable law permits or requires it. Shepherd does not promise that it will identify, assess or prevent a crisis, and this authorization does not create continuous monitoring.
I. My safety and boundary commitments
I will participate respectfully and will not threaten, harass, discriminate against or endanger a companion or another person.
I will not attend an in-person meeting while intoxicated, carrying a weapon or knowingly creating a material safety risk.
In-person meetings will occur only at an agreed appropriate location in Greater Vancouver, such as a café, park, community location, office or appointment location. I will not ask a companion to enter a home or private residence.
I understand that the First Month does not automatically renew. A recurring $79 monthly Membership starts only if I separately and explicitly agree to it.
I will arrange my own transportation and will not ask to ride in a companion's personal vehicle.
I will not ask a companion to handle medication, provide personal care, control funds, sign documents or perform another excluded service.
I will use reasonable care for mobility, weather, location and other ordinary risks of activities I choose.
I understand that Shepherd may pause or end a meeting or the service when reasonably necessary for safety, boundaries, fit, law, payment or sustainability.
J. Participant-led faith preference
I do not want prayer or faith-based conversation included.
I may request prayer or faith-based conversation. I understand this is optional companionship content, not Christian counselling, psychotherapy or spiritual authority.
Preferences or boundaries: __________________________________________________
K. Questions and voluntary agreement
I have had an opportunity to ask questions. I understand the Service Terms, Privacy Policy and this agreement. I understand I may decline optional sharing. I am choosing to participate voluntarily and believe I can communicate my preferences and boundaries.
L. Signatures
Participant signature
Date
Participant printed name
Service Order reference
Shepherd representative
Date
Optional Payer acknowledgement
If a Payer is not the Participant, the Payer acknowledges that payment does not create decision-making authority or a right to Participant information.
Payer signature
Date
Payer printed name / organization
Relationship to Participant
Operational requirement: Use a separate secure process to verify identity, capture signatures and store the completed agreement. Do not convert this page into a public web form without a privacy and security review.