This Informed Consent form is intended to inform you about the Not Your Average Parenting Book Club policies and guidelines and to ensure your agreement with these policies and guidelines. Your signature on this form indicates that you, the participant, have acknowledged that you understand and agree with the book club policies and guidelines for participation.
By signing this form I understand the following:
* Victoria Valdez, LMFT will facilitate a virtual book club meeting of 50 minutes through google meets.
* I understand Victoria is not providing therapy at any time during the 50 minutes.
* I understand that 20 minutes out of the 50 minutes is reserved for Q&A with Victoria and participants
* I understand that my question must be submitted through the Q&A submission form in advance.
* I understand that Victoria may not be able to answer my question if there is a large amount of questions ask through the Q &A form.
* I understand that this group is not a closed group and I can attend the virtual meetings at my choice with in the 5- weeks.
* I understand that I am welcome to invite new members to the group only by referring them to Victoria by email
* I understand participants must sign an informed consent before attending the book club meeting
* I understand that any parenting coaching advice given by Victoria in response to a parenting question is my responsibility to take action or to not take action.
* I understand that in take action Victoria is not responsible for any possible undesired outcomes
* I understand that Victoria is a legal mandated reporter of child abuse and if I disclose of a situation of child abuse Victoria must report.
This parenting book club success and enjoyment depends on a high degree of trust and confidentiality among participants. This book club group can provide a safe environment where you can have the opportunity to feel a sense of support from other participants during your 5 -week involvement. Furthermore, success depends on each group member, to be honest, vulnerable, and respectful about their feelings and respectful of the feelings of others.
My Personal Investment:
* I under stand that participation in the book club is free and voluntary.
* I understand that a donation is not required but appreciated
* I understand that any donation I make that my funds will be used for provide financial support for clients who can not afford typical therapist rates.
* I understand if I chose to make a donation I can do so through Venmo: @victoria-valdez-29.
Participation Guidelines:
* I understand that I am to refrain from the following behavior: discriminatory/racist comments or questions (of and not limited to ethnicity, nationality, religion, political affiliation, sexual orientation, gender, disabilities), rude or foul language, threats of any kind.
* I understand that if I violate the above guidelines the Facilitator has the right to remove me from the group meeting.
* I understand it is important to manage my own sharing time and allow for other participates time to share, to take turns, and refrain from comments that are judgmental.
Book Club Participants Confidentiality expectations and agreement:
All members of the support group will be asked to agree to a high level of confidentiality in the group sessions; this means that each participant agrees not to share any other group members' identity and personal information with others. It is appropriate to share your personal reaction and feelings about the group with others but please do not share other people's stories with anyone outside of the group.
1. You must use a secure (non-public) internet connection to participate in the group.
2. Recording of meeting by members is strictly prohibited. It is your responsibility to disable computer and device-generated recording.
Contact Methods:
The book club facilitator will send email reminders with a link for the parenting book club.
I understand that my signature of this form indicates that I am in full agreement with this informed consent.
