GROUP THERAPY CONSENT FORM
Group Name: Dads of Neurodivergent Kids – Support & Skills Group
Facilitators:
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Stacy Finch, MCP, RCC (#20192)
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Marcus Narsaiya, MC, RCC (#22430)
Purpose of the Group
This is an ongoing, open-format support and skills-based group for fathers of neurodivergent children. The purpose of the group is to provide emotional support, share parenting strategies, increase self-awareness, and explore ways to improve relationships with one’s children, partner, and self.
Group sessions are held monthly and are 60–90 minutes in length, depending on the needs of the group.
Format and Structure
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This is a virtual group conducted via Zoom.
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Participants may attend on a month-to-month basis.
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Sessions are not recorded.
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Group size may vary over time, and new members may join between sessions.
Confidentiality
Group confidentiality is a shared responsibility.
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The facilitators will maintain confidentiality except in cases where there is a legal or ethical duty to report, such as:
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Imminent risk of harm to self or others
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Suspected child or elder abuse
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Subpoena or court order
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Participants agree to:
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Not disclose the identity or personal information of group members
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Avoid recording or capturing any portion of the group
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Participate from a private space with minimal distractions
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While facilitators set clear expectations, confidentiality cannot be guaranteed due to the group setting.
Technology and Privacy
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Sessions are conducted over a secure Zoom platform.
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Participants are encouraged to join from a private, quiet location.
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If there are issues with audio lag, facilitators may recommend using Zoom for video and a regular phone call for audio.
Fees and Payment
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Group sessions are available at a rate of $60 per session or a 4-session bundle for $200.
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Payment is required upon registration or by invoice.
AFU (Autism Funding Unit) Information:
If using AFU funding, you must submit a Request to Pay (RTP) form in advance. Please use the following provider details on your RTP:
Stacy Finch, RCC #20192
113-32725 George Ferguson Way
Abbotsford, BC V2T 5M5
Phone: 778-302-3710
Email: stacy@stacyfinch.com
Voluntary Participation and Right to Withdraw
Participation is voluntary, and you may withdraw from the group at any time. We ask that participants notify the facilitators if they choose to step away from the group.
Group Guidelines
To maintain a safe and respectful environment, participants agree to:
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Arrive on time and stay for the full session
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Share only what they feel comfortable sharing
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Respect differing experiences and perspectives
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Use “I” statements when speaking
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Avoid giving unsolicited advice or feedback
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Maintain the confidentiality of others
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Abstain from substance use before or during sessions
Facilitators may ask a participant to leave the group if behavior becomes unsafe or disruptive.
Consent
I have read and understood the above information. I agree to participate in the Dads of Neurodivergent Kids group, facilitated by Stacy Finch, RCC (#20192), and Marcus Narsaiya, RCC (#22430). I understand the expectations, risks, and structure of this group and give my informed consent.