Hibou Wellness - Online Sign Up

To get started, click on “Open Form” and fill out the required fields. Once completed, a member of the Hibou staff will register you. After this has been completed both yourself and your Circle Members will receive an email from Hibou. If you need any further assistance please visit our “Contact Us” page located in the footer.

Hibou Wellness - Online Sign Up

Hibou Wellness

Name

First Name

Last Name

Phone

(###)

###

####

Mailing Address

Hibou Wellness Calls

What time do you want to receive your check-in call?

Hour

Minute

Second

When would you like to receive your second check-in call?

(Optional)

Hour

Minute

Second

What days would you like to receive a Wellness Check?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What day would you like your first phone call?

YYYY

Circle Members

Your Circle members are any people that you would like to alert if you miss your Wellness Check or push a help button. They could be family, neighbors, or friends. These Circle Members will require an email that is separate from your own.

Circle Member 1

Name

First Name

Last Name

Phone

(###)

###

####

Circle Member 2

Name

First Name

Last Name

Phone

(###)

###

####

Circle Member 3

Name

First Name

Last Name

Phone

(###)

###

####

HIBOU APPLICATION LTD TERMS OF USE

PLEASE VISIT https://hellohibou.com/terms-of-use/ VISIT TO REVIEW THE COMPLETE TERMS OF USE. DISCLAIMER. THE SERVICE IS PROVIDED TO YOU “AS IS” AND HIBOU DISCLAIMS ALL WARRANTIES AND CONDITIONS, EXPRESS, IMPLIED OR STATUTORY, INCLUDING WITHOUT LIMITATION MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT OF THIRD-PARTY RIGHTS, TO THE EXTENT PERMITTED BY LAW. WITHOUT LIMITING THE FOREGOING, HIBOU MAKES NO REPRESENTATIONS OR WARRANTIES THAT THE SERVICE WILL PREVENT PERSONAL INJURY OR DEATH, SUMMON EMERGENCY PERSONNEL, MEET YOUR REQUIREMENTS OR THAT OPERATION OF THE SERVICE WILL BE UNINTERRUPTED, CONTINUOUSLY AVAILABLE, ERROR FREE, WILL NOT HARM COMPUTERS OR MOBILE DEVICES OR RESULT IN LOST DATA OR BE SECURE AGAINST UNAUTHORIZED ACCESS. NO ORAL ADVICE OR WRITTEN INFORMATION PROVIDED BY HIBOU, ITS SUBSIDIARIES, AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, REPRESENTATIVES OR ASSIGNS, WILL CREATE ANY WARRANTY AND YOU SHALL NOT RELY UPON SUCH ADVICE OR INFORMATION. YOU BEAR THE ENTIRE RISK AS TO THE PERFORMANCE, OPERATION AND QUALITY OF THE SERVICE. LIMITATION OF LIABILITY. HIBOU, ITS SUBSIDIARIES, AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, REPRESENTATIVES AND ASSIGNS SHALL NOT BE LIABLE TO YOU FOR ANY CLAIM, LOSS OR DAMAGE OF ANY KIND ARISING OUT OF OR RELATING TO THE SERVICE OR THIRD-PARTY APPLICATIONS INCLUDING WITHOUT LIMITATION CONSEQUENTIAL, INCIDENTAL OR SPECIAL DAMAGES, LOSS OF CUSTOMER DATA, LOSS OF PROFITS, LOSS OF GOODWILL, PERSONAL INJURY OR DEATH AND ANY AND ALL OTHER TANGIBLE AND INTANGIBLE DAMAGES OR LOSSES, EVEN IF HIBOU HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGE OR LOSS. MAXIMUM AGGREGATE LIABILITY. NOTE THAT SOME JURISDICTIONS DO NOT ALLOW THE DISCLAIMER OF CERTAIN TERMS OR WARRANTIES OR EXCLUSION OF LIABILITY FOR CERTAIN DAMAGES AND, IF ANY DISCLAIMER OR LIMITATION OF LIABILITY IS FOUND UNENFORCEABLE, VOID OR DOES NOT FULLY SHIELD HIBOU FROM LIABILITY, YOU AGREE THAT HIBOU’S MAXIMUM AGGREGATE LIABILITY IN ANY CASE WHATSOEVER WILL BE THE TOTAL AMOUNT YOU PAID TO HIBOU IN THE 12 MONTHS IMMEDIATELY PRECEDING THE DATE OF THE HARM IN QUESTION.

HIBOU APPLICATION LTD PRIVACY POLICY

PLEASE VISIT https://hellohibou.com/privacy-policy/ VISIT TO REVIEW THE COMPLETE PRIVACY POLICY. YOUR PRIVACY IS EXTREMELY IMPORTANT TO US. HIBOU APPLICATION LTD., ITS SUBSIDIARIES AND AFFILIATES (COLLECTIVELY, “HIBOU“, “US“, “WE“) ARE COMMITTED TO MAINTAINING THE PRIVACY, SECURITY AND ACCURACY OF THE PERSONAL INFORMATION THEY COLLECT, USE AND DISCLOSE IN ACCORDANCE WITH APPLICABLE LEGISLATION. THIS PRIVACY POLICY (THE “PRIVACY POLICY“) IS A STATEMENT OF PRINCIPLES AND GUIDELINES CONCERNING THE PROTECTION OF PERSONAL INFORMATION OF OUR INDIVIDUAL CLIENTS, INDIVIDUAL SERVICE PROVIDERS AND OTHER INDIVIDUALS (“YOU“) (WITH THE EXCEPTION OF OUR PERSONNEL, WHOSE PERSONAL INFORMATION IS COLLECTED, USED AND DISCLOSED IN ACCORDANCE WITH OUR PERSONNEL PRIVACY POLICY).

I have read the Terms of Use and Privacy Policy

By typing my name below and clicking the check box I am electronically signing my application

Yes

Signature

Current Date

YYYY

Hibou Wellness - Online Sign Up

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