ACTION, Inc. Adult-ish Parent Agreement & Disclosure
By registering my child(ren) for the Adult-ish program at ACTION, Inc. program, I understand and agree to the following:
1. Program Purpose & Participation
ACTION, Inc. programs are designed to promote social skills, emotional regulation, self-control, and personal growth through structured, therapeutic activities.
Participation is voluntary, but consistent attendance is encouraged to achieve the best results.
I understand that my child will be expected to follow program rules, treat others respectfully, and participate in activities to the best of their ability.
I understand that I am consenting to mental health services for my child including, but not limited to: therapy, case management, and peer support services.
I understand I have to participate in the initial intake session with one of our therapists before attending the first group.
2. Safety & Supervision
ACTION, Inc. staff are trained to provide a safe, supportive environment and will supervise all activities.
I agree to provide accurate and up-to-date information on my child’s health, allergies, medications, and emergency contacts.
I understand that my child may be dismissed from the program if their behavior poses a safety risk to themselves or others.
3. Medical & Emergency Care
In case of illness or injury, staff will provide basic first aid and contact me or my emergency contact.
If emergency medical treatment is needed, I authorize ACTION, Inc. to seek such care and agree to assume financial responsibility for it.
4. Insurance & Billing
If my child is an ACTION, Inc. client, applicable services will be billed to insurance when possible.
I understand that insurance approval is not guaranteed. If services are not approved, I will be notified at least two weeks prior to the change.
5. Photography & Media
I give permission for my child to be included in photos or videos taken during program activities for program promotion, unless I provide written notice declining permission.
6. Drop-off & Pick-up
I agree to drop off and pick up my child on time.
I understand that repeated late pickups may result in additional fees or dismissal from the program.
7. Communication
I will provide a reliable phone number and check messages for important program updates.
I understand that open communication between parents and staff is vital to my child’s success in the program.