Participant Agreement Form

1. The fee for a six week, 1 1/2 hr./wk. class is $180.00 per person payable in full upon registration. The payment of $180.00 is required in advance to ensure your enrollment. It is not refundable if you change your mind after enrollment and we are unable to fill your space. Since this is a space limited class, there is no refund for missed sessions.

2. Group will begin promptly on time and end exactly on time. Please arrive before the scheduled time, as late arrivals are disruptive.

3. The information you discuss in group is confidential with certain important exceptions. We will not release any information about you without your written permission (with the exception of possible child/elder abuse or danger to self or other), and it is equally important that each of you respect the confidentiality of other group members. However, if you are mandated to attend this class by Family Court Services, we require upon registration that you sign a release of information between us and them concerning your attendance and class participation.

4. If you are court ordered, we require 100% attendance in order to receive a certificate of completion. If you miss one class, you may make it up individually with your facilitator for a fee of $50.00 per one hour session. If you are court ordered and miss more than one class, you must retake the series and repay the entire cost. (Certain emergency situations will be considered).

5. We require that you abstain from drug or alcohol use on the day of the group.

6. We require a willingness to take responsibility for your feelings. By participating in this class you are agreeing to work on yourself and any issues you may have that may contribute to an inability to cooperatively co-parent. This is a commitment which affects others in the group. If you are ambivalent or need clarification of what this means, please talk to one of the facilitators before signing this agreement.

7. We require an intention to learn new and better communication and negotiation skills as well as anger management skills and a willingness to consistently practice these skills in group.

8. There will be no bashing or blaming of the other parent or the courts or legal process in group. You will instead have an opportunity to appropriately express your angry and hurt feelings with other group members.

9. This is an educational skills class. It is not therapy or to be substituted for therapy. The facilitators will not get involved in or mediate your conflict with the other parent. Should you be involved or become involved in legal proceedings, by signing this form you are agreeing to the following: "Neither I nor my attorney, nor anyone else acting on my behalf will request that Shonnie Brown or Happy Morris testify in court or in other legal matters on my behalf or release information about me for legal proceedings.' _____ (please initial)

I agree to the above policies and I understand that the facilitators reserve the right to request any participant to leave the group with refund of fees for incompleted classes if he/she is not compliant with all of the above policies.

Signed _________________________________________   date ______________________

Please read if court ordered: I agree to sign a release of information to participate in this class for the purpose of the facilitator reporting my attendance/progress to the referring party. I also agree that the instructors may share information about me with each other.

Signed _________________________________________   date ______________________