Restore Small Groups are offered by group facilitators who have participated in a Restore group themselves and been trained to lead. We hold ourselves to the highest standards of conduct within our group process. However, our groups are not offered as professional therapy and should not substitute for the opinion of a licensed professional counselor. We honor and value confidentiality in our groups. However, we are obligated to waive confidentiality if there are:
- Suspicion of child, elder, or disabled individual abuse - We reserve the right to report actual or suspected child, elder, or disabled individual abuse of any type to the proper authorities.
- Threats to harm self or others - We reserve the right to disclose to the appropriate person, agency or civil authorities any threats of harm that a person may attempt or desire to do to one’s self or to others.
Additionally, I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Restore Small Groups cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others.
I voluntarily seek services provided by Restore Small Groups. I attest that when I attend group:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
I hereby release and agree to hold Restore Small Groups harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Restore Small Groups, or that may otherwise arise in any way in connection with any services received from Restore Small Groups. I understand that this release discharges Restore Small Groups from any liability or claim that I, my heirs, or any personal representatives may have against Restore Small Groups with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Restore Small Groups. This liability waiver and release extends to all employees or facilitators of Restore Small Groups.
I understand that I will also need to sign this waiver in person on the first night of group.
