By filling out this form you are acknowledging the following:
I am the parent/guardian of the above-mentioned minor, and I hereby consent for my child to participate in the Step's Foundation Retain Your Brain Program or the Survival Program. I understand that Step's Foundation, Inc is not a licensed counseling agency, our Executive Director holds a master's in Mental Health Counseling and uses it to educate students and families along with her team.
Description of Services: The purpose of our programs is to offer support and education to teens who are dealing with mental health difficulties (extreme stress, depression, anxiety, etc), student's that need extra guidance and mentorship, students that are falling behind in classes, and/or students that just want to be prepared for life after high school. I understand that these groups DO NOT provide counseling, but is an educational support program designed to assist with coping skills, help students build confidence, help students navigate through challenging issues and behaviors, offer self-reflection techniques, and help demonstrate how to deal with issues that life will present. Working amongst a group of peers helps students to understand that they are not alone. They are able to get support from others who are experiencing similar challenges or situations, or who have learned to adjust well after experiencing a similar challenge or situation in the past. I am aware that despite the fact that peer educators (facilitators) may be professional counselors, these groups WILL NOT provide group counseling.
Our Survival Program touches on many tough topics. With our program community partners, we do touch on sex education, teen domestic violence, sexual assault, drug addictions, alcoholism, and human trafficking. Students will learn how to best protect themselves should they choose not to remain abstinent, and the consequences of not being protected. Students will get educated on healthy relationships, boundaries, and consent. We are promoting abstinence to the fullest but we know that peer pressure arises and we want to help students understand the consequences should they choose not to protect themselves and be safe. Parents you are allowed to be part of these conversations if you wish, we certainly want this to be a family engagement piece. These conversations open the door for you as well to talk with your students so that they aren't getting misinformation from the internet or teen friends. Our goal is to help students lead a strong healthy life and make better informed decisions by advocating for themselves with knowledge.
Confidentiality: I understand that in order to encourage students to participate actively, parents and outside observers will not be allowed to attend the retain your brain peer support groups. I understand that participation in our groups is completely voluntary and confidentiality is addressed and respected. I understand that the exception to this is the peer mentors' (facilitators) legal and ethical responsibility to take appropriate action in the case of someone intending to do harm to themselves or others, if abuse or neglect is suspected, or if illegal activity is reported.
I give consent for Step's Foundation, Inc to use artwork, images, or quotations made by my student in brochures, literature, and/or other public relations activities.