Bereaved Parents Consent Form

Date(s)

Group Program – four (4)* sessions throughout the year
*this is subject to change and participants will be notified

Purpose of the Program

This group program aims to provide psychological education, strategies, and/or therapeutic support, to parents/caregivers who are bereaved from childhood cancer, in a group setting. The purpose of this consent form is to ensure you understand what participation involves so you can make an informed decision.

Nature of Participation

• This program may involve psychological education, group discussion and opportunities for peer support.
• Participation is voluntary. You may choose not to actively participate (just listen) or answer certain questions. You are able to withdraw any time from participating in this group and this will not impact upon access to other services or the group in the future.
• This program is not a substitute for individual therapy.
• I understand that I do not have to attend all four (4) sessions for the year and that I can attend the sessions that are the most relevant to me.
• I understand that there may be Master of Psychology students who may attend as part of their placement with the Childhood Cancer Association. 

Potential Benefits

• Increased understanding of grief and loss
• Development of new coping strategies and skills
• Peer support from group members.

Potential Risks

• Discussions may involve sensitive or personal topics.
• You may experience emotional discomfort during sessions.
• While all group members are asked to maintain confidentiality, absolute confidentiality cannot be guaranteed in a group setting.
• If you experience distress, you may request a break or follow-up support.

Confidentiality & Data Protection

All personal information gathered during the provision of the group program will remain confidential and secure. However, there are exceptions. To learn more about how we maintain confidentiality and collect and store your information, please refer to *** page. 

Behaviour, Non-Attendance, Illness & Liability

• I engage in behaviour that is in breach of the group rules, I may be asked to leave.
• If I am unable to attend the group program, I will notify the Childhood Cancer Association as early as possible, or else I might be responsible for any costs incurred by the Childhood Cancer Association.
• I give the Childhood Cancer Association staff and volunteers consent in the event of any accident or illness to obtain such medical assistance as is required and I agree to meet any costs involved therein (e.g. transport via ambulance to a medical facility).
• I will not attend the group program if I am not well.
• The Childhood Cancer Association is not liable for any loss, damage, injury, or expense arising from its actions, omissions, or those of its staff or volunteers, including negligence. 

Consent to Participate

In signing this form, I have read and understood the information provided. I agree and consent to the above conditions for my attendance at the Bereaved Parents Group provided by the Childhood Cancer Association.