Social/Emotional Girls' Group Sign-up

You Can Sit With Us, is a supportive and empowering group for 5th grade girls who are entering and preparing for the transition to middle school. Led by a therapist, this group focuses on building confidence, learning how to be a good friend, finding healthy friendships, setting boundaries, and developing emotional regulation skills to handle new social and academic stressors.

Through engaging activities, discussions, and hands-on tools, girls will gain practical skills they can carry with them into middle school and beyond. Each participant will also take home meaningful items to help reinforce what they’ve learned.

Details:

Dates: July 14, 15, and 16
Time: 9:00 AM – 12:00 PM (9 total hours)
Cost: $210
Snacks: Provided daily

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I give permission for my child to participate in the group facilitated by Chelsea Carnes, MSW, LCSW. This group is designed to support social skills, emotional awareness, confidence, and healthy peer relationships through structured activities, discussion, and therapeutic guidance.

I understand that participation may include group conversations, interactive exercises, and activities that encourage emotional expression and social engagement. While every effort will be made to provide a safe, supportive, and respectful environment, I acknowledge that emotional discomfort may arise at times as part of the learning and growth process.

I understand that this group is not a substitute for individual therapy, and while it is led by a licensed therapist, it is intended as a skills-based and supportive group experience rather than individualized mental health treatment.

I acknowledge that there are inherent risks in any group setting, including the possibility of emotional distress, interpersonal conflict, or accidental physical injury during activities. By signing below, I accept these risks and agree to release and hold harmless Willow Counseling Collective, its staff, and representatives from liability related to my child’s participation, except in cases of gross negligence.

I understand that reasonable precautions will be taken to ensure safety. In the event of a minor injury or concern, appropriate care will be provided, and I will be notified as needed.

Confidentiality:
I understand that confidentiality will be encouraged and discussed with all participants; however, it cannot be guaranteed in a group setting. Participants will be asked to respect one another’s privacy, but I understand that what is shared in group may be discussed outside of it by peers.

By signing below, I acknowledge that I have read, understand, and agree to the terms outlined above, and I give permission for my child to participate in this group.

Payment Agreement and Registration Policy

To secure your child’s participation in the girls social-emotional group, all required registration steps must be completed. This includes submission of all intake and consent forms through the client portal and full payment of the invoice.

Please note that your child is not officially enrolled in the group until all documents have been completed and payment has been received in full. Spots are limited and will be reserved on a first-come, first-served basis once these requirements are met.

Cancellation and Refund Policy:

• Cancellations made on or before June 15th will receive a full refund.
• Cancellations made between June 15th and July 3rd will receive a 50% refund.
• Cancellations made after July 3rd will not be eligible for a refund, as Mrs. Carnes has reserved this time exclusively for the group

Late Cancellation and No-Show Policy:

Due to the limited nature of group spots, any late cancellations or missed sessions (no-shows) will not be eligible for reimbursement or refund.

By proceeding with registration, you acknowledge and agree to the terms of this payment and cancellation policy.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.