Playful Intervention LLC
Child & Family Therapy Services
Consent to participate as a peer model for Psychological Group Therapy Services
I hereby grant permission for my child to participate in Playful Intervention LLC
group social skills through drama groups as a peer model.
I understand that my child will be participating in a therapeutic group with the
main treatment goal being: to teaching social skills through playful interaction.
I further understand that this is a volunteer position (no remuneration) and that my
child willingly accepts the responsibility of being a leader and role model in this
group.
I agree to commit my child’s service to the entirety of the group session for which
he/she is enrolled as a peer model, and understand that faithful attendance is
mandatory except in the case of illness.
I agree to hold Playful Intervention LLC, and it’s managing directors and employees
free and harmless from any and all claims, costs. losses, damages, recoveries,
settlements, and expenses of any nature or kind which may be incurred by
participation in group activities.
Thank you for your commitment and participation!
Signed (Parent or Guardian) ______________________________________________
Date: __________________________________________________________________