GROUP THERAPY PARTICIPATION AND CONFIDENTIALITY AGREEMENT
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1.1. This Confidentiality Agreement is made between WARIF and [insert name] (referred to as “Participant”) of [insert address] in relation to the participant attending the group virtual therapy sessions and interventions organized by WARIF for the beneficiaries of its programmes.
1.2. WARIF’s primary objective is to create a safe environment for beneficiaries of the virtual therapy sessions and the Partcipant has a duty to:
1.2.1. keep all information discussed in the group confidential and may not discuss any information including and not limited personal data, experiences, reactions, requests of the other participants or remedies prescribed during or in connection with the group virtual therapy sessions.
1.3. Confidentiality may be breached by the group facilitators under the following situations:
1.3.1. If it is disclosed that a minor, which is defined as a child who is 17 years of age or younger, has been or is at risk of being physically, sexually, or emotionally injured by another individual;
1.3.2. If it is disclosed that one of the group members intends to physically, sexually, or emotionally injure another individual; or
1.3.3. If it is disclosed that a group member intends to inflict personal injury on herself.
2.0. Online platforms for video conferencing and virtual meetings will be utilized for the group virtual therapy sessions. The risks associated with using such online platforms may include unwanted and disruptive intrusions, resulting in third parties gaining temporary access to group meetings. While WARIF strives to ensure that all necessary precautions will be taken to avoid such occurrences, in the unlikely event that such unwanted exposure is encountered, we will enforce measures to curtail the effects of such exposure, provided that neither WARIF nor the Participant shall be liable for any unwarranted disclosures resulting from such intrusions.
3.0. Either of WARIF or the Participant may terminate this agreement by written notice. Provided that the confidentiality obligations under this Agreement shall remain in force for a period of 2 (two) years after the termination of this agreement.
4.0. This agreement shall be governed by Nigerian law.
IN WITNESS WHEREOF the parties hereto have caused this Agreement to be executed.
Kindly fill the form below:
(Full name in capital letters) Date
WARIF CENTRE, 6 Turton Street, off Thorburn Avenue Yaba, Lagos