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Warrior Group Teens Registration Form

*Note Unless you are 18 years old, this registration requires parental permission. There is a $20 materials fee for the group.

Student Information

First Name

Last Name

Phone number

Age

What school do you go to?

Do you participate any Extracirricular Activites?

Parent Information

Name of Parent or Guardian

Phone Number

Other Information

Do you attend church? If so, where?

Please describe the problem, including how long it's been going on?

Please explain any church support you have received

Consent

The Warrior Group is a coaching program that runs six to eight weeks. It is not a “drop-in” program, so if an event will prevent me from attending a group session (e.g., sports, camp), I will let the facilitator know. I realize that missing groups hampers my progress and also makes it hard for others in the group to trust me. I will be asked to discontinue participation if attendance becomes an issue.
I realize that I am encouraged to share on a personal level, but will never be forced to do so. I can choose to share according to my own comfort level.
I realize that Warrior Group will contain frank discussion and education about sexuality and behavior. We will be respectfully discussing sensitive topics.
I understand that a parent meeting may be offered to support my son’s progress in the Warrior Group. This meeting would be designed to provide educational content and practical tools to help me create a supportive and informed environment at home. Although not therapeutic in nature, these sessions aim to offer guidance and peer support. I agree to maintain confidentiality regarding any personal information shared by other attendees during these meetings.
I recognize that Warrior Group requires homework outside of the group and will be using the Valor series material. The program only works if I do the work. The program is voluntary, but I will be removed from the group if I choose not to participate. Likewise, if my behavior pulls another participant away from recovery, I will be removed from the group.
I commit to bring my workbook every week to the group. This is required. It is not optional. Likewise, I commit to come each week with homework and tasks completed, or personal problems and questions to process with the group.
I commit to total confidentiality within the group. I will not disclose outside of group personal identifying information or stories about other group members. This includes sharing with my parents/family information or stories that other group members share about their family or situation. If sending email or texts, I will use extra precaution and seek permission before sending messages. Likewise, I will be careful to protect others’ privacy when posting to any social media sites. Failure to abide by confidentiality rules may cause me to be removed from the program.
I realize that the facilitator with Warrior Group will sometimes use texts or WhatsApp as a way of communicating and staying in touch with participants. Likewise, the young men are required to communicate with one another through various means including texts and phone calls. All participants need a way to communicate with one another.
I understand that I may revoke my consent at any time by written notice, and that my participation in Warrior Group is conditional on the above consent.
I understand that if I disclose that I am abusing someone or have been abused, or if I become suicidal or homicidal, that the group facilitator will be required by law to report such information to legal authorities.
I agree to have no sexual contact with other group members, nor to engage in solicitous behavior. Failure to abide by this agreement will cause me to be immediately removed from the program. Furthermore, I agree to not share graphic or inappropriate information with other group members in ways that might hinder their progress.
I recognize the program requires homework outside of class. My recovery is only as productive as my commitment to my personal work. The facilitator does not hold magical insights for my life. Personal growth requires hard work and many hours of effort by me. The facilitator can guide and help me develop self-awareness, but is incapable of fixing my problems. There is no guarantee that everyone in the group will be successful.
I realize that the Warrior Group is congruent with Biblical teaching, and encourages participants to seek spiritual support from religious leaders. We will occasionally discuss various Biblical concepts that apply to the problems we are discussing.
Experiential activities and methods are sometimes used in the Warrior group. This could include supportive physical contact such as a shoulder squeeze or a hug. If supportive physical contact happens, I understand the following:

a. The intent shall always be to offer nurturing support.
b. I can accept or refuse any form of supportive physical contact at any time.
c. If I accept any form of supportive physical contact, this does not obligate me to continue to accept; I can change my mind as my comfort level changes.
d. I can say STOP at any time and that all physical contact will stop immediately.
e. I do not have to offer any explanation as to why I choose to stop the physical contact

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I have read and fully understand the information provided above about the program. I realize the Warrior Group is considered coaching and consultation, not therapy. I will discuss any concerns or questions about the program with the group facilitator during the discovery call. I understand that I can leave the group at any time. By signing this document, I agree to accept the risks listed in this form and the risks explained to me by the facilitator. By signing this form I also pledge to keep confidential all personal information shared by program participants who attend the Warrior Group.

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Parent Signature

Date Signed

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Upon submission of this registration, you will be automatically directed to a calendar. Please choose a convenient date and time for a confidential conversation with you, your student and the group facilitator. During this call, you can discuss any questions or concerns about the group, and the facilitator will ask you a few brief questions to ensure the group is a good fit.

Submit

​​​​​​​Student Information

Parent Information

Student Information