We appreciate your interest in our free support group for parents! It is important that you understand this is not a therapy group but a support group led by mental health professionals. Please read this form carefully and contact our office with any questions.
I acknowledge that the Kernersville Counseling Center (KCC) Parenting Support Group is not psychotherapy, not the same as a therapeutic setting, and not a substitute for mental health treatment.
I hold KCC harmless. Participation in KCC support groups is entirely voluntary and is focused on a peer-to-peer learning experience where members support/encourage each other in their roles and responsibilities as parents. KCC’s parenting support groups are not offered as a clinical/ therapeutic experience. I hold KCC harmless of any injury arising during my participation in the parenting support group.
I agree to participate in the parenting support group in such a manner that ensures confidentiality:
- What’s said in the group, stays in the group.
- I am free to tell my story and share my experience in the group, and learn from the stories and experiences of others, but will safely hold private and confidential the stories of others and not discuss or share them outside of the group.
- I agree not to photograph or record the group in any way or any form.
I agree to participate in the support group in such a manner that ensures each group member is heard:
- To be silent and actively listening when one person is talking & sharing their story.
- To abide by the group norms/rules, regulate my reactions, pay attention to my own emotions, and not act out in ways that take away from the group process.
- To make every effort to resist making or expressing judgments of people, their actions, or their experiences.
I agree to participate in the parenting support group in such a manner that ensures:
I refrain from Conflict of Interest: I do not use the support group to promote any business, resources, lobbying, or electioneering of any political interests, nor to solicit any financial exchange or assistance.
Does Kernersville Counseling Center, PLLC (KCC) have your permission to send information about the agency, including newsletters, upcoming special events, speaker meetings, trainings, and even closings/delayed openings in the event of bad weather? Please note that our e-mail notices are sent securely, and your email address is not visible to others, ensuring your privacy and security.
By checking the box labeled "yes, I agree" below, you release Kernersville Counseling Center, PLLC, its officers, directors and employees, contract personnel, sponsors, personnel, or any parties connected with KCC from any liability that may arise out of or relate to your participation in KCC support groups. You waive all claims against such person(s) in connection therewith. Please remember that you must abide by the support group guidelines, and failure to comply may result in your being asked to leave the group.