Registration & Consent for Parents/Guardians Support Group
This group is for parents/guardians of transgender & nonbinary/gender nonconforming (or gender questioning) kids of any age, providing a safe space for parents to connect, learn, and support each other.
Name *
Email *
Address
Phone number *
Informed Consent: When I participate in a support group, I will hear information of a confidential nature concerning other group members. I understand the importance of confidentiality and agree to keep information and experiences shared in groups in the strictest confidence. Within certain limits, information revealed by participants in the support group will be kept strictly confidential by the facilitators and will not be revealed to any person outside of the group or to any outside agency without your written permission. An inherent risk with support groups is the confidentiality of information disclosed, as all group members verbally agree to hold information disclosed as confidential but law and ethics do not bind this agreement. There are certain situations in which the facilitator may be required by law to reveal information obtained during any form of therapy to other persons or agencies. These situations are as follows: 1) if there is a threat of grave bodily harm or death to self or another person; 2) if the facilitator becomes aware of a situation of neglect or harm of a minor or a vulnerable adult; 3) if a court of law issues a legitimate subpoena. BY TYPING IN MY NAME BELOW, I am acknowledging that I understand and consent to these support services/activities for myself to be arranged by Deb Horton Counseling at 10 Ferry Street, Concord NH. I am aware this is a process group and insurance will not be billed. *
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