Dear group member and/or parent/guardian: It is necessary that you read this contract completely and understand it before signing. If you are under the age of 18, you must also have your parent/guardian sign as well. If you do not sign this contract, you will be unable to attend the group.
1. I understand that regular attendance is required. I understand that if I miss more than one session I may be dropped from the group. I understand that I must attend at least five of six group sessions held on July 8, July 15, July 29, August 5, August 12, August 19.
2. I agree that what is spoken by myself and the participants of this group is confidential and I should not talk about other group member's personal information outside of the group.
3. I understand that any group work in association with Cornerstone of Hope/OSU is confidential. Information shared with the group facilitators and other participants is private. I understand that parents/guardians have legal rights to information discussed in group pertaining to their child. There are some important exceptions to privacy listed below. In such cases, I understand that my privacy rights will be waived:
Ohio law requires COH and my student's group staff to report any suspected physical, sexual, or emotional abuse or neglect to social services.
If a person expresses intent to bring harm to him/herself or others; COH and/or OSU reserves the right to inform other family members and/or make appropriate referrals if necessary, including law enforcement.
If information is ordered by the court, including a subpoena, COH or OSU will attempt to contact the parent/guardian about the requested information. Even if the parent/guardian opposes the release, the court may still require compliance with the order.
At times, COH/OSU staff members may use case examples of group members, including artwork, for educational training, fundraising efforts, and published newsletters. COH/OSU upholds confidentiality and will not use names without written consent.
4. In order to create a safe and supportive environment, I understand that expressing inappropriate and/or disruptive behavior may cause me to be dismissed from the group.
5. I authorize the exchange of information between appropriate group personnel and Cornerstone of Hope representatives regarding pertinent issues in order to provide continuity of care.
6. I agree that my child's artwork, photographs, or representations may be used in future educational training, display, and/or publication by Cornerstone of Hope or OSU. I understand that my child's name will not be used in conjunction with any presentation or discussion of the work.
7. I understand that in cooperation with OSU personnel, my child will be seen by a trained and qualified professional from Cornerstone of Hope.