Personal Growth Group Informed Consent

I, _____________________________________________, agree to participate in a personal

growth group instructed by a master’s student. I understand that I only need to share what I am
comfortable with sharing, and that I can end my participation in this group at any time. I am
aware that this group will cover an array of topics regarding personal growth and development.

I also understand that I am not to discuss the things other members of the group said outside of
the group session without their written permission. I know that all things said or done in this
group are to remain confidential unless I have written permission to share what has occurred or I
am required by law to share.

Participant signature: ______________________________________Date:______________

M.S. Counselor Signature:___________________________________Date:______________