Support Group Informed Consent Form

So you're thinking about joining our Favored Tribe!

Please read through the information below and feel free to ask your questions about our sessions and/or anything about us. Once you are ready to participate, please sign this informed consent form below so we will have on our records that you have read the information and that you have been properly informed about the group.

CONFIDENTIALITY

We respect each and everyone's right to privacy and confidentiality and we will make sure to maintain it that way. However, please understand that this is not absolute and is limited to provide for by law. Certain limitations are as follows:

• Threatening one's self or another that may result in physical harm;
• An act of physical or emotional abuse against a child or any person;
• Sexual abuse against a child where the child is living with the abuser;
  Whenever we are summoned by court order to disclose information against a participant. However, we shall notify you and let you exercise your privilege in the right to deny the disclosure of your records with us.
• Your prior written consent to release records.

CONDUCT AND RELATIONSHIP

For the safety it is necessary that the following is required to be complied with by its members:

1. Discussions made within the group session are not allowed to be discussed outside with anyone and should maintain the practice of confidentiality in order to build trust with fellow members;
2. Members should maintain positivity and not induce disrespect among others;
3. Maintain conduct that brings respect to fellow members' thoughts, emotions, or behavior.

WHAT TO EXPECT

The sessions consist of processing on the issues that may be presented and others will give their feedback and reaction towards the said issue. This helps each member understand the issue from a different perspective in order to understand others. This also helps with one's reflection about his or her situation which can then help for insight and personal growth.

CONSENT

I agree to adhere to the norms and expectations for Support Group as indicated above. I acknowledge that I have the opportunity to ask questions.