Confidentiality/Informed Consent Form

To be printed out, read, signed, and given to group facilitator at first group meeting.

I understand that participating in an accountability group of this nature may be very difficult:

1. I may feel deep anger, fear, shame, anxiety, depression, or loneliness.
2. I may remember unpleasant events.
3. I may be offended by another person's experiences or comments.
4. Someone may break confidentiality and give out my name or personal information about me.
5. Someone outside of the group, through some accident or coincidence, may find out I am a member of this group or discover personal information about me.

I also understand that there may be great benefits to participating in this group:

1. I may stop certain sexual behaviors.
2. I may deal with my sexual thoughts and feelings more effectively.
3. I may understand my sexuality better.
4. My relationships with others may improve.
5. I may grow spiritually.

In joining this group, I realize and agree to the following:

1. I agree to keep all information shared in the group, including the names of group members, strictly confidential. While I may share information about myself with anyone I choose, I will not share any information about others with my wife, family, friends, pastor, counselor or anyone else who is not a group member.
2. The group facilitator and group members have no training in counseling, nor can they guarantee positive results from any suggestions that they give. I am fully capable of discerning good and bad advice, and I do not hold them responsible for any negative consequences to participating in this group or following their advice.
3. I recognize that the group facilitator is required by law to inform local authorities of any unreported cases of rape or child molestation which I reveal. I recognize that he is required to inform the same authorities if, in his estimation, I am in danger of committing suicide or of carrying out murderous threats against another.
4. I do not hold Lost and Found Ministries, the church where the meeting is located, or any other associated or participating organization responsible or liable for any negative results of my participation in this group.
5. I have fully understood this form and sign it to demonstrate my agreement to everything stated here and to join an accountability group.

Signature ______________________________

Date ________________

(Print name here) ______________________________

Group facilitator's signature _____________________

Date _____________