Support Group in a Box – Facilitator Agreement

Thank you for choosing to serve as a group leader (“Facilitator”) for individuals participating in the Support Group in a Box Program (“Participants”). We are glad you are here and want this to be a safe, supportive space.

By serving as a Facilitator, you agree to distribute to each Participant the attached Participant Acknowledgement Form. Please distribute the form to all Participants, in order to assist Participants with understanding the limitations of the Program and your role as Facilitator.

By signing below, I acknowledge and agree that I have read, understood, and agree to the terms and conditions of this Agreement:

1. Not a Substitute for Health Care or Advice
   • I understand that the Program is not intended to evaluate overall health or any specific health condition.  I understand and acknowledge that The Autoimmune Association does not employ healthcare providers and that any person participating in or facilitating the Program does so independently.
   • I understand that this support toolbox is designed for peer connection, shared experiences, and encouragement. I understand that these meetings do not constitute therapy, nor will they include medical, psychiatric, or other professional health services, diagnosis or treatment.
   • I understand and agree that this Program is intended to provide only general information and it does not establish a patient-provider relationship between any Participant, Facilitator or The Autoimmune Association, nor between any individual and any healthcare provider.
   • I understand and acknowledge that I, as well as any Participant, must seek care from my own physician(s), or other appropriate healthcare professional(s).  Any research or guidance provided to me is of an informal and generalized nature, and I will not consider any such information to constitute formal advice or treatment.
2. Confidentiality
   • I understand that I am to respect the privacy of others. What is shared in the group should remain in the group.  I agree to keep and maintain the information shared in the group as confidential, except to the extent required by law.
   • I further understand that, while confidentiality is expected, it cannot be absolutely guaranteed.
   • I understand and agree that, as Program activities do not constitute therapy or healthcare, no formal treatment record will be created and the protections afforded to health records under applicable law (e.g., “HIPAA”) do not apply to any information shared.
3. Voluntary Participation
   • I understand that my participation in any meeting is voluntary and I, or any Participant, may withdraw from the Program or any meeting at any time.
4. Emergency or Crisis Situations
   • I understand and agree that this Program is not designed to provide emergency or crisis intervention.
   • If I ever feel unsafe, in danger of harming myself or others, or in need of urgent medical or mental health care, I will call 911 or go to the nearest emergency department.
5. Release of Liability
   • I acknowledge and agree that The Autoimmune Association is not responsible for any decisions, outcomes, advice, or actions taken by me, any Facilitator or any Participant related to this Program.
   • I understand and agree to participate in this Program at my sole risk.
   • I further agree to indemnify, defend, and hold harmless The Autoimmune Association, its officers, employees, and/or agents against any and all claims, suits, or actions of any kind whatsoever for liability, damages, compensation, claims, expenses and liabilities whatsoever related to my participation in the Program.
6. Respectful Space
   • I understand that The Autoimmune Association is committed to maintaining a safe, welcoming environment. I will facilitate and engage with kindness, respect, and sensitivity to others’ lived experiences.