As evidenced by my signature below, I agree to participate, and understand that it is my choice to participate, in the Cancer Support Community support group(s) and other programs.
I acknowledge that, with group therapy and other CSC classes, there is risk of disclosure of personal and confidential information by participants in the group to individuals outside of the group. I agree that I will not disclose personal information learned by me during the course of any group session and will protect each participant's right to confidentiality.
I agree to hold the group facilitator and/or the Cancer Support Community at Prisma Health Cancer Institute, Cancer Support Community at Cancer Survivors Park, Cancer Survivors Park Alliance (CSPA), Prisma Health System, The Center for Integrative Oncology and Survivorship (CIOS) and all officers, agents, employees, representatives, executers harmless from any claims or liability resulting from my disclosure of confidential information to a third party outside of a group session. I further agree not to hold her/him/they responsible and release him/her/they from the same, for/from any claims of liability that I could assert as a result of disclosure of my confidential information by co-participants in the group(s).