Free family worksheet

Make privacy part of the care plan.

Agree on one purpose, the smallest useful signal, who can see it, what remains private, and how the technology can be paused or removed.

Local form. Haven & Signal does not receive or store what you type. Entries stay in this open page unless you print or copy them; screenshots, browser extensions, printing, and shared-device access can create separate copies.

Local form. Haven & Signal does not receive or store what you type. Entries remain in this open page unless you print or copy them; screenshots, browser extensions, printing, and anyone with access to this device can create separate copies.

Haven & Signal · Family worksheet

Family Privacy Agreement

Keep a copy with the account record and revisit it whenever the setup changes.

Purpose and boundaries

Name the concern together. Capability is not permission to collect more.

Person this agreement supports Home or setting One purpose agreed together Technology covered

Data and alerts

Separate what is collected from the narrow signal the family actually needs.

What can be collected or stored? What will create an alert? Retention and deletion setting

People, accounts, and access

Give every viewer an identity, a reason, and a removal path.

Primary viewer and reason Account owner and recovery contact Additional viewers or services People who must not have access How access is reviewed and removed

Private spaces, times, and pause control

Make privacy boundaries visible and usable in ordinary life.

Private spaces or camera-free areas Private times and visitor rules How collection is paused or revoked

Remote support, nearby help, and verification

Give each helper a narrow role and make unexpected urgency a reason to stop.

Remote support rule Nearby helper and physical access Unexpected request verification rule

Emergency-response rule and exit

Define the family response rule and a complete way out before either is needed.

Agreed emergency-response rule When the setup pauses or ends Removal and deletion steps

Agreement preflight

Check these together. An unchecked item is a question to resolve, not permission to assume.

Everyone understands what the technology collects, what it does not prove, and who receives alerts. Each viewer has an individual account with the strongest available sign-in protection. The person being supported knows how to pause collection or revoke access. Private spaces, private times, visitors, audio, and camera boundaries are written down. Remote support and nearby-help permissions are separate, specific, and removable. Unexpected requests for money, codes, passwords, or remote access always stop for independent verification. The family has reviewed how to remove the device and request or confirm data deletion.

Person being supported Family participant

Date agreed Next review

Use it well

Permission should stay understandable.

Agree togetherBegin with the person whose home, routine, body, or location will create the information.

Collect lessChoose the narrowest signal that answers the family’s real question, with private spaces and times.

Keep an exitReview viewers, pause controls, retention, cancellation, reset, and deletion whenever the setup changes.

Read the privacy guide Connect the communication plan