Grad Group PARTICIPANT AGREEMENT For: STRIVE Grad Group MEETINGS Grad group meetings are designed to keep you motivated and on track after the completion of your STRIVE series. Each grad group will run for 4 weeks and meet bi-weekly. You must commit to a 4 week minimum. You can continue to re-commit to additional grad groups as you feel you need them. You must have attended a minimum of STRIVE Series I to attend grad group meetings as these are for patients that have graduated one or all of our series. The fee for each 4-week group is $160.00. You may opt to pay $40.00 co-pay each week ($20 to Dawn & $20 to Nancy), or pay in full $160.00. If paying weekly there will be an $80.00 goodfaith deposit showing your commitment to the program due at your first meeting. Requirement for group is a minimum of 10 participants due to time and money invested by practitioners.
I _________________________ (print your name), agree to participate in Strive grad group meetings. I understand that I will be required to attend all 4 sessions in each grad group I commit to. I understand that the fee for all 4 meetings is due whether or not I miss meetings. This is due to the commitment both practitioners have made, both in time and finances, to run this group. I will participate in group exercises that are designed to help me develop more positive thinking patterns and healthier thinking.
I understand that once I have made the commitment to participate in the program, the morale of the group will depend in part on my consistent attendance and involvement. I understand that if I drop out prematurely or attend inconsistently, this will be disruptive and may hurt the morale of the other group members. Please check the box below that best describes how you feel about attending consistently: I definitely plan to attend all sessions in this group. I anticipate that I may not be able to attend all the sessions.
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This material is confidential and contains proprietary information and intellectual property of Nancy Lum & Dawn O’Meally. Neither these materials nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission. Grad Group Participant Agreement – Strive Meetings (rev.12-19-2012hn
I understand that I will be asked to do daily self-help assignments between meetings. These assignments will consist of activities such as reading and doing self-help assignments. I understand that my learning and growth will depend on the amount of time I spend doing self-help assignments between group meetings. I understand that my failure to do this homework may diminish any learning and growth that I might experience during this program. Please check the box below that best describes how you feel about the homework assignments: I am definitely willing and able to do the self-help assignments. I am not sure that I will be able to do the homework assignments consistently. I am not willing to do the homework assignments consistently.
I have read this form and I have had the chance to ask questions about the purpose of the STRIVE meetings as well as the nature of my participation. I agree to participate along the lines described here.
_________________________________ Sign your name
_________________________________ Today’s date
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________________________________ Group Facilitators
________________________________ Today’s date
This material is confidential and contains proprietary information and intellectual property of Nancy Lum & Dawn O’Meally. Neither these materials nor any of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission. Grad Group Participant Agreement – Strive Meetings (rev.12-19-2012hn