Family Agreement Form

 

 

FAMILY   A GREEMENT   F ORM  

 

Before   c ompleting   a nd   s igning   t his   f orm,   p lease   r ead   a nd   d iscuss   t he   F AMILY   I NFORMATION  

PACKET   w ith   e veryone   i n   y our   f amily   w ho   w ishes   t o   p articipate   i n   a   g roup   a t   t he   S tarfish  

Program.  

 

1. We   u nderstand   t hat   t he   S tarfish   P rogram   p rovides   s upport   a nd   d oes   N OT   p rovide   t herapy  

or   c ounseling.  

 

2. We   u nderstand   t hat   t he   S tarfish   P rogram   d oes   N OT   h ave   r ecords   f or   l egal   i ssues   r egarding  

children   o r   a dults.  

 

3. We   a gree   t o   a ttend   a ll   s essions   o f   o ur   g roup.     W e   u nderstand   t hat   i f   w e   m iss   t wo  

consecutive   s essions   e xcept   f or   i llnesses   o r   c rises,   w e   m ay   b e   d ropped.     W e   a gree   t o   c all  

and   i nform   t he   s taff   w hen   w e   a re   u nable   t o   a ttend   o ur   g roup.  

 

4. We   a gree   t hat   a   c hild   m ust   a lways   b e   a ccompanied   a nd   s upervised   b y   a   p arent   o r   a nother  

adult.     W e   a gree   t o   a lways   h ave   a   p arent   o r   a nother   a dult   r emain   i n   t he   b uilding   w hile   t he  

child   i s   i n   g roup.     W e   u nderstand   t hat   a dults   h ave   t he   o ption   o f   p articipating   i n   t he   a dult  

support   g roup   w hile   t he   c hild   a ttends   t heir   s upport   g roup.  

 

5. We   h ave   r ead   a nd   u nderstand   t he   F AMILY   I NFORMATION   P ACKET.     W e   h ave   d iscussed   t his  

information   a nd   a gree   t o   a bide   b y   t he   g uidelines   o f   t he   S tarfish   P rogram.  

 

 

Print   N ame   o f   A dults   a nd   C hildren    

 

Signature   o f   E ach   P articipant  

 

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