Mindful Moments is a psycho-educational group program to support children in developing a mindful lifestyle. A mindful lifestyle means living with greater awareness, connection, and intention. Mindful Moments is not counselling or therapy. However, participants may find that they benefit most from the group experience if they share openly their own ideas and experiences. For those parents who would like more support, one-to-one coaching sessions with the group facilitators are available on an as-needed basis.
Privacy & Confidentiality
I understand that the information collected from myself and my child(ren) will be kept confidential under the Freedom of Information and Protection of Privacy Act (FOIP), Section 33(c) and will only be used for the purposes of this program.
All personal information is stored in our secure client information database, Penelope. Any program reporting from this database is done in a way that does not identify you or your child(ren) as individuals. Further, we keep the information only for the length of time necessary to fulfill the purpose for which it was collected.
I understand that the information I share is confidential and will not be released except if:
· I provide written consent
· there is risk of harm to me or others
· abuse or neglect of a child or a dependent adult may be happening
· there is a legal order that requires the release of information.
For example, information to Calgary Police Service, RCMP, Child and Family Services, Probation /Parole, Alberta Health Services, Homefront Society, or your referral agency will not be released unless at least one of the above conditions is met.
Information may be shared about me or my child(ren) with members of the Mindful Moments team. I understand that this would be done to provide the best services for me or my child(ren). I also understand that the information shared would be on a “need to know” basis.
Child Protection Services Acknowledgement
In the event that YW Mindful Moments has reason to suspect the occurrence of physical, sexual, or emotional abuse, neglect, or exploitation of a child, YW Mindful Moments will, as required by the Child, Youth and Family Enhancement Act to report their concern to the local Child and Family Services Authority.
First Aid Permission
I hereby authorize staff at YW Mindful Moments to administer medical treatment and/or first aid for any minor injury or accident while my child is in their care.
Emergency Care Authorization
I give my permission for emergency care decisions to be made by YW Mindful Moments staff regarding my child/children in the event of any emergency that impedes regular program operations, and I shall be financially responsible for such advice and services.
Assumption of Risk and Informed Consent
Participation in the program has risks and hazards, I waive any and all claims for myself and child(ren) that I have or may have in the future against, and to release and discharge from any and all liability, the YW Calgary Mindful
Moments, directors, managers, employees, agents, volunteers and representatives, and their respective successors and assigns, or any of them in connection with or participation in the YW Calgary Mindful Moments program and activities (collectively, the “Releases”), for any and all of the following:
· Personal injury
· Death
· Property damage; and/or
· Any other loss, damage or expense
Grievance Procedure
Your feedback is important to the Mindful Moments program, if you have any concerns or suggestions,
please discuss it immediately with the Mindful Moments Supervisor. If the concern is not resolved at this level, you will be directed to contact the Manager, Child Development Services. This person will attempt to meet or speak with you within five working days. Please contact the program supervisor at (403) 250 7500.
Program Consent
I confirm that I have read and understand this agreement, I agree to be bound by its terms, and I am aware that by signing this agreement I am waiving certain legal rights against the YW Calgary Mindful Moments program including the right to sue or claim compensation following an accident.
I also understand that by signing this agreement I consent for child(ren) to participate in the YW Calgary Mindful Moments program. I may withdraw consent for myself and/or my child(ren) at any time, for any reason and without prejudice.