The Children's Advocacy Center
Serving Bastrop, Lee and Fayette Counties

to participate in utilizing the CAC's therapy garden that is located outside of the therapy rooms. This form serves as a supplement to the general informed consent that was signed when initiating services. Our CAC has implemented a raised bed therapy garden that is located behind our building and is accessed via our back door. The CAC will supply all needed materials and tools needed to water, weed, feed, and pick from our garden. The therapist will be with the client at all times while outside the building.

Assumption of Risks There are possible risks of utilizing the therapy garden, including, but not limited to: • Accidental injuries from tripping or falling while walking outside • Physical dangers including insect stings, other allergens, exposure to heat/cold, etc.

By signing this form, I agree to the following:
1. I understand that participation in utilizing the therapy garden is completely voluntary.
2. I agree to communicate with the counselor if I am uncomfortable physically or emotionally while participating in utilizing the therapy garden. In such a case, the outdoor session would discontinue outside and would instead continue in the office.
3. I take full responsibility for my medical and physical well-being and will not hold the CAC legally or financially responsible for any medical conditions and/or accidents that may arise while utilizing the therapy garden.

By signing below, I understand that I am consenting to the above-mentioned conditions and risks regarding Outdoor Therapy.

59 Texas Loop 150 West, Bastrop, TX 78602
Phone (512) 321-6161 Fax (512) 321-6164
www.childrensadvocacycenter.org

A 501 (c) (3) Non-Profit Corporation, Federal Tax ID #74-263301