Sweet Deeds Open Group: Sign-Up Form and Informed Consent

Name*

First NameLast Name

Email Address*

Phone Number *

City*

What brings you to Open Group? *

Age - Open Group is for participants at least 18 years or older.*

In order to be eligible for Open Group, at least one of the following must be true. Check all that apply.*

I have previously received or qualified for financial assistance through Sweet Deeds Foundation.I was referred by a nonprofit partner of Sweet Deeds and have financial need.Other

What are you hoping to get out of Open Group? (Check all that apply)*

A safe space to connect with othersPractice relational / emotional skills in communitySupport through a difficult seasonGrowth in self-awareness and coping skillsOther

Are there any topics you'd hope to explore in a group setting?

Are you currently in individual therapy? *

YesNoPrefer not to say

Confirmation of Attendance*

I understand this group meets online Wednesdays from 12:00 - 1:00 PM CT.

What additional meeting times work best for you? (We may add new times in the future).

Questions or Comments

1. Nature of the Group

I understand that Open Group is a program of Sweet Deeds Foundation, a non-clinical nonprofit organization.

Support, Not Therapy: I acknowledge that this is a support group designed for community connection and skill-building. It is not group psychotherapy, clinical treatment, or a crisis intervention service.
Facilitation: I understand that while the group is led by a Licensed Professional Counselor (LPC), they are acting as a facilitator, and my participation does not establish a clinical therapist-patient relationship with them.

2. Continuity of Care

I understand this group is meant to complement my individual work, not replace it.

3. Confidentiality & Safety

Group Privacy: I agree to keep everything shared within the group strictly confidential to protect the privacy of all members.
Mandated Reporting: I understand that the facilitator is legally required to break confidentiality if they believe there is a risk of harm to myself, harm to others, or if the abuse of a child or vulnerable adult is disclosed.
Crisis Disclosure: I acknowledge that Sweet Deeds Foundation does not provide 24/7 crisis monitoring. In an emergency, I will contact 988 or local emergency services.

4. Liability Release
I voluntarily choose to participate in this group and agree to release Sweet Deeds Foundation, its staff, and its contracted partners and therapists from any liability arising from my participation in this non-clinical peer support setting.

I have read and agree to the Participant Agreement and Informed Consent above.*

YesNo

Today's Date

Participant Signature

Sweet Deeds Open Group: Sign-Up Form and Informed Consent

Participant Agreement & Informed Consent