Trailblazers: Informed Consent Logo
  • Trailblazers: Informed Consent

    Please carefully read the following information and sign at the bottom of this form.
  • Trailblazers is a group for kids ages 10+ making space to connect with self, others and nature though play! Led by two therapists, Orion Zick and Sarah Block, group sessions may include creative projects, playful movement and mindful exploring, looking to acknowledge the benefits of time spent outside and in connection. Join us for enriching outdoor experiences where exploration, growth, and fun come together in the great outdoors!

    This group is not considered a healthcare service, and is therefore NOT billable to insurance.

  • Overview

  • Seattle Play Therapy group programs are offered in-person, virtually or by hybrid format. Groups provide an opportunity to meet with others in a shared environment. Some groups focus on education: learning a new skill, problem solving challenges, and finding new ways of being. Other groups involve learning more about yourself, practicing and experiencing connections and problem-solving challenges.
     
    While our providers may also be trained mental health professionals and/or licensed therapists, they will not be providing you with a mental health diagnosis, and therefore groups are NOT considered a healthcare service. Groups are not designed to replace therapy by a licensed professional and are not designed to address specific and/or severe mental health diagnoses or safety risks. Some individuals may not be a good fit for groups.

  • Risks and Benefits

  • There are risks and benefits involved with participating in groups. It is possible that you or your child may experience uncomfortable feelings, for example, embarrassment or frustration while working alongside others in the group context. You or your child may also experience joy, excitement, or fulfillment. It is normal for a variety of emotions to arise when learning to share a space with new people. If you or your child have any questions, concerns, or intense feelings that arise from the group experience, you are encouraged to let your facilitators know so they can problem solve ways to make the experience more comfortable.

  • Confidentiality

  • We will not share any information about you or your child, family or participation in SPT groups with anyone outside of Seattle Play Therapy.  
      
    Although we will discuss with the group the importance of respecting one another’s privacy, we cannot guarantee that personal information shared within the group will not be shared by others participating. Also, for groups that meet online, your privacy may be further compromised as it relates to others overhearing you in your space or in other people’s space.  
      
    SPT groups are not a healthcare service, meaning that the legal protections of confidentiality for healthcare information do not apply to Groups. However, since the group facilitators are mandated reporters, we are still required by law to disclose certain information including suspected abuse or neglect of children under RCW 26.44 or suspected abuse or neglect of vulnerable adults under RCW 74.34. 
     
    As part of groups, photos of artwork and play-based creations can be taken for consulting, teaching, research, and educational purposes. Any photos taken would be de-identified and not connected with you or your child’s personal information. Unless you explicitly state to the SPT team otherwise, by consenting to groups you give your permission to SPT to take photos of and use de-identified artwork and play-based creations in published works or presentations for educational purposes.   

  • Logistics Information

  • Meeting Times and Location
    Trailblazers will meet in person on each Friday in August from 10am-12pm. The session dates are listed below.  

    • August 1st: Golden Gardens (8498 Seaview Pl NW Seattle, WA 98117. Parking lot by the playground)
    • August 8th: Arboretum (1145 E. Lk Washington Blvd, Seattle WA 98112, next to the Japanese Gardens)
    • August 15th: Discovery Park (Discovery Park South Parking Lot)
    • August 22nd: Arboretum/Foster Island (Foster Island Parking lot)
    • August 29th: Carkeek Park (NW Carkeek Park Rd, Seattle, WA 98177. Parking lot by the playground) 

     

    Fees
    The cost for SPT groups is paid in advance and includes all supplies. This cost is non-refundable, including if you or your child is absent from any of the group meetings. The cost for groups cannot be reimbursed by health insurance, as this is not a healthcare service. You may select and provide payment below for the group sessions your child is participating in. 

    Here are the following payment options:

    Option 1: $350 total package for all 5 sessions.

    Option 2: $250 total package for any 3 sessions. You may select the dates your child is participating in the payment section.

     

    Group Facilitators and Contact Information

    Sarah Block   
    email: sarah@seattleplaytherapy.com
    phone: (206) 553-9977 ext. 8220

    Orion Zick
    email: Orion@seattleplaytherapy.com
    phone: (206) 553-9977 ext. 8717 

  • It is not required that you or your child participate in each meeting, nor is there a penalty for absences. However, as payment is made in advance, it would be an opportunity lost for you or your child to miss out on any given day. In some groups, each week is planned ahead of time with a curriculum and daily goals. Previous week’s topics and/or projects will not be reviewed if missed. Additionally, the knowledge and tools discussed in groups are cumulative. It is important that you or your child be engaged with the other group members to form important connections and absorb all the benefits possible from this program.

  • Consent to participate in Trailblazers

  • By signing for myself or on behalf of my child, I understand and agree to the contents of this document, specifically including the following highlighted points: 

    • I understand the risks and benefits involved with myself or my child participating in this group process. 
    • I understand that my child’s participation in a group is completely optional and that I may withdraw my consent at any time, though I will not be able to receive a refund (except in extenuating circumstances).  
    • I am aware that participation in groups do not guarantee improved or definitively changed behavior in myself or my child. 
    • I understand that groups do not involve the diagnosis or treatment of mental health disorders. 
    • I understand that by choosing to access groups there are inherent risks to my own or my child’s confidentiality.   
    • I understand that groups are not a substitute for counseling, psychotherapy, psychoanalysis, mental health care, or substance abuse treatment. I will not use it in place of any form of diagnosis, treatment, or therapy. 
    • I understand that groups are not a form of mental health care and are not covered by insurance, nor is my own or my child’s confidentiality protected in the same legal manner as health care. 
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        5 SessionsPurchase all 5 Trailblazers Group Sessions
        $350.00
          
        3 SessionsPurchase any combination of 3 Trailblazers Group Sessions
        $250.00
          
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