This online form contains two releases for you to sign: an authorization that would allow us to release information about you to certain people; and an authorization that would allow us to use pictures of you and/or your child/children to raise awareness of SAFEchild. Thank you for completing both releases!

Below the form is information about your rights as a program participant at SAFEchild. Please make sure to read it as well!

Your Rights as a Program Participant at SAFEchild

1. The right to confidentiality

When you share with us information of a private nature, other participants and SAFEchild staff are required to keep that information confidential. Private information includes your name, details of past experiences, and details about how or why you are participating in a SAFEchild program.

Limits to confidentiality include information that has the potential to harm you or someone else, such as thoughts and/or plans of suicide, homicide, injury or child abuse. SAFEchild staff are required by law to report such disclosures to the appropriate authorities.

2. The right to be treated with dignity and respect

3. The right to participate in a safe environment, free from harm

4. The right to be free from discrimination

All SAFEchild program participants will be treated equally regardless of race, color, national origin, age, gender, political affiliation, religion, disability or sexual orientation.

5. The right to receive services that constitute parent education

SAFEchild group programs are not a form of counseling or therapy, but rather are psycho-educational, providing information related to parenting in a supportive environment.

6. The right to consent or refuse SAFEchild service

7. The right to be informed of program-specific policies and expectations

8. The right to receive documentation of your participation at SAFEchild

This documentation will specifically outline dates of contact with SAFEchild, group attendance and successful completion of a program. To ensure that you receive the documentation in a timely manner for a court date or meeting, we must have a week’s notice.

9. The right to be informed of the reason(s) if SAFEchild declines to provide or continue providing services

Reasons to refuse continued service include, but are not limited to, lack of attendance, aggressive or other inappropriate behavior, non-compliance with group rules, and intoxication during a group meeting.

Download Your Rights as a Program Participant at SAFEchild.