PARTICIPANT AGREEMENT For: STRIVE TO SUCCEED MEETINGS I _________________________ (print your name), agree to participate in Strive group meetings. I understand that I will be required to attend all sessions in the series. I understand that during each session 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 series. I anticipate that I may not be able to attend all the sessions.
I understand that I will be asked to do daily self-help assignments between sessions. 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 sessions. 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.
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This material is conďŹ dential 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. Patient Agreement – Strive Meetings (rev. 8-10-2012hn
If I miss a session due to illness or some other factor beyond my control, I agree to give the group facilitators notification at least 24 hours in advance, I understand I am still responsible for paying for materials for missed sessions. 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. Patient Agreement – Strive Meetings (rev. 8-10-2012hn