Group Members Name *

First Name

Last Name

Phone

(###)

###

####

Age

14

15

16

17

18

19

20

21

Confidentiality & Non-Disclosure *

This Confidentiality and Non-Disclosure Agreement ("Agreement") is entered into by and between all members participating in the therapy group (hereinafter referred to as "Participants"). Participants agree to maintain strict confidentiality regarding all discussions, personal experiences, and information shared within the therapy group sessions. This includes but is not limited to, any personal details, experiences, or identities of fellow Participants. Participants acknowledge and understand that breach of this confidentiality agreement may result in immediate termination from the therapy group and potential legal consequences.

I Agree