Adult contact and request information
The form is for adults. It collects the adult contact name, safe email or phone contact, optional city/county, state/jurisdiction, requested service and timing, pack duration, funding and installment preferences, safe-contact choice, and acknowledgements. Campaign tags and the page path may be recorded for request routing. A submission timestamp and reference are generated. This information can still be sensitive in context; share only what is safe.
What stays off this form
Do not enter a child’s name, date of birth, diagnosis, school record, court or custody documents, case number, shelter address, identity document, or financial account information. No document upload or child account is provided by this intake. This adult-contact design is not a blanket claim of COPPA, FERPA, or HIPAA compliance for future services.
Purpose, storage, and access
Request data is stored in ARKTIK’s Azure lead store for service review and follow-up by authorized operators. Microsoft/Azure provides hosting and processing infrastructure. This form does not subscribe you to marketing. Only the selected contact method and voicemail instruction should be used. A different channel requires your agreement.
Protected service records
Student, family, medical, or legal documents require a separate restricted workspace and appropriate authority/consent. Do not send those documents to this form or a general collaboration library. Access, sharing, retention, and deletion arrangements are confirmed in the relevant service agreement before collection.
Retention and your requests
There is no promise of indefinite storage. Retention depends on purpose, applicable obligations, and any legal hold. Ask for access, correction, deletion, or a change in safe-contact instructions using the Privacy / data request option. Identity is verified before disclosure or change. We explain applicable retention limits and any reason data cannot be deleted.
Browser behavior
The request page uses short-lived browser session storage for the receipt reference, service-guide routing category and next-step message; it does not store the submitted contact form there. Hosting systems may record technical request logs. The local Ledger tool processes chosen files in the browser without uploading them through that tool.
Contact
Request a privacy or contact-preference review. Use adult safe-contact details only. This request channel is not for emergencies.