Smart PDF Form

Being In God's Presence - Drop-In Group

Thank you so much for your interest in our group. We are excited to share space with you. Hannah and I will be running this group every week for the rest of 2026 with some exceptions (if we are both unavailable due to vacation, sickness, etc.). The drop-in format gives you flexibility to attend when you are able and to pay as you go. It also means the group of people who attend will likely change from week to week. Our goal is always to make the space feel safe, creative and warm despite the change of attendance. All discussions and art will be confidential as the group is therapeutic in nature. Spaces are limited to 12 participants per week. We will open with a prayer and check-in, meditate on scripture, make art, share about the art and then close together. We will choose scriptures based on themes throughout the year. Themes could last between a month to 4 months. Our aim is to continue or change themes as we go, responding to the desires and needs of the group. We have made the minimum cost of $10 per session with the option of paying more between the range of $10-30 per session if that is something you would like to offer. We are trying out this cost for now since we wanted to make the group accessible to people as we are building this community. If money is an issue for you but you would like to attend please reach out and we can talk about some options. Payments can be e-transferred to Katlyn at blueflamearttherapy@gmail.com or paid through this website.
Consent & Intake Form

These pages ask for a little bit more information about you, lays out your rights as a participant and some ways you can help us create a safe space online. It is necessary for you to fill this out and sign it before joining the group for the first time. This form is valid for all of 2026. If you are a returning member who has already signed this form you don't need to fill this out. Please navigate back to the group page to sign up for a group spot in the returning member section.

PERSONAL INFORMATION
Name:*
Preferred Name (if different):
Pronouns:
Sex:
Gender (current gender which may be different than what is indicated on your insurance policies or medical record):
Birthdate:*

MonthDayYear
Date
Phone Number:*
Email:*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What time zone do you live in?
Emergency Contact Name:*
Emergency Contact Phone:*
Emergency Contact Relationship:*

QUESTIONNAIRE

Please review the questions below, and answer them to the best of your ability at this time. This helps us understand how we can best support you. All information you provide is confidential.
Relaxation and enjoymentMake new friends/communityBuild self-confidenceTo work through traumaLearn about relationship with Jesus, God, Holy SpiritDeepen my existing relationship with JesusLearn new scripture meditation techniques
Other reasons are:
Do you have any mental health issues or significant things you are working through? All answers will be kept confidential and are useful for the therapist to know. Please answer no if you do not.*
Have you received art therapy in the past? If yes, what did you find helpful?*
What would you like to gain from this group at this time?*
Anything else you would like us to know about you?
Please add anything else that you would like us to be aware of to support your art therapy experience:
Where did you hear about this group?
Are there other days and times that would work better for you to join this group? If so please let us know which days and times.
If you are unable to pay the $10 fee for the group please let us know here and how much you would like to pay.
YesNo
Thank you for taking the time to complete this questionnaire. We look forward to meeting and talking with you further. Please note that all information provided is kept confidential and will not be shared with anyone without your written consent.

Online Art Therapy Group Informed Consent - Adult

Please read over and initial each section and signing at the end to let us know you understand and consent to the following. If you are a minor please contact Katlyn at blueflamearttherapy@gmail.com for a different form.
Participation Consent
- I agree to participate in virtual art therapy sessions facilitated by art therapists Katlyn Lim and Hannah Arabsky. Katlyn and Hannah are supervised by an art therapist registered with the Canadian Art Therapy Association (CATA) and adheres to the CATA Standards of Practice. I understand that records of therapy sessions will be maintained and that these records are confidential and stored securely according to the provincial privacy standards.
I understand and consent to the above statement about my participation*
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Safe Online Therapeutic Space
- My art and aspects of my art therapy sessions may be shown and discussed with the art therapists' supervisors in individual supervision. I understand that the art therapist and supervisor are held accountable to the ethics of the profession with regard to client confidentiality.
- The use of the Google Meet video platform. The security of this platform cannot be guaranteed by Blue Flame Art Therapy. However, Google Meet does protect privacy by using anti-hijacking controls for video meetings and is encrypted thus securing data in transit. The only personal health information that Google Meet will have access to is my name and email address. This information is used only for the purposes of setting up session times.
- I will create a safe and uninterrupted space to ensure confidentiality during the video session. I understand that my space at home becomes part of the virtual art therapy studio. This means that I will ensure that others will not enter my space, and I will minimize background noise and distractions (such as notifications on devices).
- I will prepare for the video session by coming dressed in appropriate attire for an appointment with a professional, setting up my device five minutes in advance of the start time, and having my artwork/writing/questions/reflections ready to share, if needed.
- If I am interested in making art prior to/during the video session, I will take responsibility to have a variety of art materials of my choice. The therapist will provide support in planning for useful art materials and art directives.
- I understand that neither I nor the art therapist are permitted to record the video sessions, unless written consent is provided by both parties.
- If there is an internet connection issue during the session, I will close the application and try again. If unable to connect, I will wait for the art therapist to connect with me via email or phone number.
- This consent form is valid for and covers all drop-in sessions I attend for the year of 2026.
I understand and consent to the above statements about creating a safe online therapeutic space : *
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CLIENT RIGHTS
- I have the right to discontinue attending the group at any time, for any reason, or for no reason. You always have the right to seek alternative treatment, including a different therapist.
- It is encouraged to discuss discontinuation from the group with the art therapist when possible so that some closure can be processed together, and other suitable community or professional resources may be discussed that you may be interested in accessing.
I understand and consent to the above statements on my client rights:*
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RISKS AND BENEFITS
Participating in any therapy sessions has its risks and benefits, and it's important that you are aware of the most likely cases. Risks may include, but are not limited to, having uncomfortable feelings/thoughts, difficult memories are brought up, gaining new skills/confidence that impact areas of your life, or shifts in relationships with others. It is not unusual for you to feel worse after you start art therapy or after a session, but these feelings should decrease as time goes on. Benefits may include, but are not limited to, improved connections with yourself and/or others, elevated mood, more effective communication, a boost in psychological well-being, decreased effects of personal problems and better regulation and coping skills.
I understand and consent to the above statements on the risk and benefits of art therapy:*
Initials
PAYMENT AND CANCELATION
- The minimum cost for each drop-in session for the group will be the total amount of $10 with the option of paying between $10-30 for each session if I so desire. If the $10 fee for sessions is not affordable other options can be discussed with the therapists.
- Payments can be made per session, monthly or in installments set by me and the therapists.
- Payments can be made through the Blue Flame Art Therapy website or e-transferred to Katlyn at blueflamearttherapy@gmail.com. If payment can't be made through email, other options will be discussed and agreed upon with the art therapists.
- I will try to give the art therapists notice of my absence from a session 6-8 hours before.
- If for any reason the art therapists needs to cancel a session due to health or emergency reasons they will refund the client fully for this session.
I understand and consent to the above statements on payments and cancellation:*
LIMITS OF CONFIDENTIALITY
I understand that all my personal information will be kept confidential unless:
- there is a threat of bodily harm to self or others
- there is indication of child and/or elder abuse
- the information is requested by subpoena for court purposes
- permission is given to consult with other individuals/professionals as required
I understand and consent to the above statements about limits of confidentiality:*
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By signing below you give your consent to all of the statements on this page.
Client Name:*
Signature:*

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Date:*
Katlyn Lim & Hannah Arabsky, DKATI
blueflamearttherapy@gmail.com
Hannah.Arabsky@salvationarmy.ca
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Being In God's Presence - Drop-In Group

Consent & Intake Form

PERSONAL INFORMATION

QUESTIONNAIRE

Online Art Therapy Group Informed Consent - Adult

Participation Consent

Safe Online Therapeutic Space

CLIENT RIGHTS

RISKS AND BENEFITS

PAYMENT AND CANCELATION

LIMITS OF CONFIDENTIALITY