Valor-Teens Class (Online) Registration

Psychotherapy and counseling are different from classes. I understand that I am participating in a “class” which is not considered psychotherapy or counseling. It provides education and support in my recovery but does not provide clinical insight or individual therapy. Similarly, I recognize that the class cannot replace my need for therapy or counseling. I will ask the class instructor about therapy or counseling if needed. The following items have been discussed with me and my questions or concerns resolved. I commit and agree to the following items:

1. I realize this is a class.  Although I may find healing in my life while participating in the class, the focus will be on educational components of recovery from addictive and unhealthy behaviors.
2. I understand that the class is designed for heterosexual individuals. I understand that the class does not provide Gay Affirmative Therapy (GAT). The instructors who teach the class are not trained nor equipped to handle specialized issues within the LGBTQIA+ community. I can ask for a specialized referral if needed.
3. I am encouraged to share with the class on a personal level, but will never be forced to do so. I can choose to share according to my own comfort level.
4. I understand that appropriate attire is important due to the nature of the topic. I do not want to create distractions for class members and will avoid wearing tight clothing, mini-skirts, tank tops, midriffs, short-shorts, controversial or explicit graphics, or anything similar.
5. I understand the format for the class is online via Zoom. This platform has been secured for privacy and complies with HIPAA laws.
6. I agree to utilize a headset during my participation in the zoom online class, and to make sure I am in a private location. I will make sure my environment is free from distractions and maintains confidentiality for others in the class. I realize I am required to show my face during the class and cannot turn off my video.
7. I recognize the class requires homework outside of class. My recovery and healing is only as effective as my commitment to my personal work. The instructor facilitating the class does not hold magical insights for my life. Addiction recovery and personal healing require hard work and many hours of effort by myself as the student. Instructors can guide and help me develop self-awareness, but are incapable of directly fixing my life struggles. Recovery and healing is only as effective as the effort I put into it.
8. Neither Family Strategies nor any of its therapists or class instructors guarantee that everyone who participates will be successful.
9. I commit to total confidentiality within the class. I will not disclose outside of the class personal identifying information or stories about other class members. This includes sharing with my family or friends information or stories that others share about their situation. If sending email or texts, I will use extra precaution and seek permission with the recipient before sending messages using either method. Failure to abide by confidentiality rules may cause me to be removed from participation in the class.
10. I understand that I must use caution when posting to social media. Confidentiality applies to online contexts.
11. I release confidentiality and give permission to Family Strategies and its professional staff to discuss my personal information with one another for the purpose of class instruction. “Professional staff” includes, but are not limited to, the Executive Team, Clinical Supervisors, therapists, class instructors and interns who have expertise regarding specific issues related to the topic. Additionally, I understand Family Strategies has a team of specialists who have training in this topic, and I give my consent to other instructors to visit my class throughout participation in the class. I understand that my recovery plan will focus on my own work, and not on a specific instructor or therapist. I give my consent to other instructors, therapists, interns, and supervisors at the agency visiting, observing, or facilitating my class at any time, and I consent to their accessing our individual and class records in order to collaborate and coordinate.
12. I understand that I may revoke my class consent at any time by written notice and that my participation in Family Strategies’ class is conditional on the above consent.
13. I understand that if I disclose child abuse, suicidal, or homicidal ideation that the class instructor will be required by law to report such information to the appropriate authorities.
14. I agree to have no sexual contact with other class members, nor to engage in solicitous behavior. Failure to abide by this agreement will cause me to be removed from participation in the class.
15. I realize that the class is not a drop in program. If an event will prevent me from attending a class, I will let the instructor know. If I decide to exit the class I will discuss withdrawal with my instructor.
16. I will take responsibility for my own work in the workbooks. Recovery is an individual process that requires total honesty and consistency. I may choose to share my own progress with my friends or family.
17. I realize that classes will never provide the one-on-one interaction that individual therapy provides. I understand that I will need a primary therapist to help me with individual issues as they arise.
18. I realize that I am encouraged to seek spiritual support from religious leaders. The class does not impose spiritual or religious agendas. Similarly, I realize that I am encouraged to make 12-step meetings part of my recovery program.
19. I understand that my ongoing class participation is reliant on the judgment of the instructor and/or my individual therapist. Removal from the class does not reflect negatively on me, rather it is a judgment based on what is best for my own healing. There are times it would be appropriate to return to individual or family counseling for stability, then return back to the class at a later time. Similarly, I understand that I have the right to leave the class at any time, and will provide a simple explanation to the instructor if I choose to leave.
20. I understand that due to the nature of the class, neither Family Strategies nor its therapists may release class records without compromising the confidentiality of other participants, which is prohibited by Arizona law. All class records are stored “together” on a single form, which makes individual notes for the class unavailable for copy and release. I understand that if I require class records for any legal reason I (or my health care decision maker) must make such a request in writing, and Family Strategies and its therapists are restricted to supplying only class dates and general topics reviewed during classes.
21. Family Strategies does not allow either the instructor or student to record any portion of video or telephonic classes unless prior consent has been obtained in writing for the purpose of training or supervision.
22. I realize that Valor- Teens will contain frank discussion and education about sexuality and behavior. We will be respectfully discussing sensitive topics.
23. I recognize that Valor- Teens requires homework outside of the group. The program only works if I do the work. I realize that the program is voluntary, but that I will be removed from the group if I choose not to participate. Likewise, if my behavior pulls another participant away from recovery, I will be removed from the program.
24. I commit to bring my program binder (with it’s lessons and notebook) every week to the group. This is required.  It is not optional. Likewise, I commit to come each week with homework and tasks completed, or personal problems and questions to process with the group.
25. As a participant, I understand that I will be required to identify a mentor (sponsor) in addition to my parents, with whom I can regularly discuss my growth in the program.

1. I realize that Family Strategies cannot bill insurance for classes. These are provided at a cash rate only.
2. I understand that I must register online for one, two, or three months at a time.
3. I understand that classes are pre-paid for one to three months at a time. If I choose to withdraw from class mid-month my fees for that month will not be refunded. However, if I pay for more than one month at a time, I may receive a refund for months I have not attended any classes as long as I give the instructor 24 hours' notice before the first class of the month.

I have read and agreed to the above conditions for participation in the class. I understand the information and any questions I have were discussed with me by the class instructor or other employee at Family Strategies. I acknowledge that the class is not psychotherapy or counseling and only provides education and support. I will seek professional therapy when necessary. I understand that I can leave the class at any time. By signing this document I agree to accept the risks of participation in the class.