CONSENT FOR PARTICIPATION
I, hereby consent to my participation in Capital Area Healthy Start’s Support Group(s). I have also been made aware and understand the following:
● Groups are facilitated by Lola Brognano, LCSW #15182 or Rachel Tribble, RCSWI #15631, for CAHS, however I am fully aware this is not therapy.
● Groups are support based and no individual therapeutic advice will be given.
● Our social workers are required by HIPAA Confidentiality regulations to only release information if it poses a safety issue for self or other(s). All other information discussed in the group will remain confidential with all in attendance in agreement.
● Any concern for safety is required by law to be reported.
RELEASE OF LIABILITY
I understand that the information being discussed and shared is of a sensitive, vulnerable and possibly triggering nature and is inherent in any environment. I knowingly hereby consent to my presence at any of Capital Area Healthy Start’s Support Groups. I do, hereby, for myself, my child, heirs and executors forever waive and release CAHS, its board members, committee of advisors, licensed and pre-licensed clinicians, volunteers or any other paraprofessional from any and all claims, actions, demands, rights and damages of any nature whatsoever, that I may have at any time against CAHS.