Please read the form below and sign. Your signature indicates that you understand and agree with the content of this form. If you are registering as a couple, please have each person complete this form. Your participation in the workshop/group will be confirmed upon the receipt of your payment along with the submission of Questionnaire and Informed Consent Form.
The group or workshop that you are participating in is a psycho-educational experience. This means that you will be experiencing interplay between education, and personal processing and growth. Participation in this experience can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek attendance at a psycho-educational group or workshop. During the psycho-educational process you may also encounter unpleasant feelings or thoughts. You may also make decisions about changes you would like to make in your behaviors and/or relationships. This experience may result in changes that were not originally intended. Attending a psycho-education process is not a substitute or alternative for individual or couple’s counseling. If you are in need of names of counselors before, during, or after the psycho-educational process, your facilitators will be happy to provide you with a list of providers.
I understand that I am agreeing to participate in a psycho-educational experience that carries with it the potential of positive benefits and/or unpleasant feelings. I understand that I may experience both expected and unexpected change. I understand that this is not considered, nor a substitute or alternative for individual/couple counseling, and that I am free to participate in my own counseling during, or after this experience. I also agree to practice self-care while I participate in this experience. If I am feeling overwhelmed, I will slow down, or take a break and step away. I understand that I am free to participate to whatever degree is comfortable for me, and I will not push myself beyond that to meet any perceived expectations of myself or others.
