Flock of Care Program 

Celebrating milestones, one duck at a time

Participation Consent Form

Program Description: The Flock of Care Program is a joyful recognition initiative designed to celebrate the achievements and milestones of our private duty nursing clients-from pediatrics to adults who live with chronic physical, congenital, or developmental disabilities. Through the simple, cheerful symbol of a rubber duck, we honor courage, growth, and everyday

Purpose & Goals: Promote positivity and engagement between clients, families, and nursing staff Celebrate client milestones, both large and small Create a culture of recognition and joy in care delivery Strengthen connections among clients, caregivers, and the organization

How It Works: Each client is recognized with a themed rubber duck to mark a milestone or special occasion. Nurses and caregivers may nominate clients for recognition when they achieve a personal goal, reach a developmental milestone, or show resilience and positivity.

Milestone Categories & Example Ducks:

Welcome Duck - first week/month of nursing services

Celebration Duck - birthdays and personal achievements

Brave Duck - hospital discharges or medical progress Strong Duck - therapy or rehabilitation milestones

School Duck - starting a new school year or program

Loyal Duck - annual anniversaries with the care team

Seasonal Ducks - holidays or special events Staff Involvement & Recognition

Staff Involvement & Recognition: Staff may nominate clients for recognition and present the duck with a small tag or certificate. A photo or brief story may be shared (with consent) to highlight the accomplishment. Staff can also receive 'Caregiver Ducks' for outstanding compassion, teamwork, or service.

Community Engagement: With appropriate consent, share 'Flock Highlights'-client stories and photos-on internal boards, newsletters, or social media to spread encouragement and celebrate progress.

Participation is completely voluntary, and you may choose to opt in or opt out at any time without affecting the care or services you receive.

I choose to OPT IN to participate in the Flock of Care Program and give permission for my name and contact information to be shared with the program's coordination team for the purpose of receiving care and outreach.

I choose to OPT OUT of participation in the Flock of Care Program

Consent Options-Photo Release (Must sign photo release form)

Acknowledgment and Signature I understand the purpose of the Flock of Care Program and my participation choice above. I understand that I may withdraw or change my consent at any time by notifying the program coordinator or nursing supervisor.