Form Test HomeForm Test Client Consent to Counselling and Group Services FSYR is committed to excellence in counselling services for children, youth, adults, couples and families. We are an inclusive, diverse organization that upholds the right for everyone to be treated with dignity, respect and without discrimination. We believe in the importance of a safe and secure environment to promote the fullest development of individuals, couples and families. Our counsellors are trained professionals registered with their respective regulatory colleges. Our counsellors have Masters level training or equivalent, and we are also a training site for graduate students. You will be informed of your counsellor’s credentials in the first session. For the purpose of this document, the term counselling includes group services. Benefits and Risks Counselling has risks and benefits. Many people find it helpful. Counsellors aim to help achieve change with as minimal distress as possible. Occasionally, counselling can elicit difficult emotions. At all times, you have the right to make decisions about your service and participation, including to not discuss a topic, to terminate the session and/or counselling. Counsellors are responsible for explaining the foreseeable risks and benefits associated with withdrawing or withholding consent. Although there is no guarantee of improvement for every situation, FSYR’s counselling staff have been trained to use techniques and interventions that have been researched and proven to be beneficial for most people.CONSENT TO COUNSELLING AND GROUP SERVICES(Required)I am 16 years of age or older and voluntarily consent to the conditions of service outlined above for myself. First ChoiceI am 12 years old to 15 years old and have been informed of the benefits of involving my parent(s) in the counselling process. I consent to the conditions of service outlined above and would like to proceed without my parent(s) knowledge or approval.I am a parent/guardian of a child under the age of 16. I voluntarily consent to the conditions of service outlined above and for my child to receive counselling services at Family Services York Region.Parent / Guardian Name(Required) First Last Client Name(Required) First Last Client Date of Birth(Required) MM slash DD slash YYYY Signature(Required)