Florida PICS Survivor & Co-Survivor Support Group

Participant Agreement & Confidentiality Acknowledgment

Please review each commitment before your first meeting. Complete this form, then open your email app to send your acknowledgment to Michael for review.

Participation is voluntary. Share only what feels comfortable, and contact Michael@lifeaftericu.org with questions before signing.

Agreement version: September 30, 2026 · v1

Your commitmentsProtect identities and storiesI will keep other participants’ names, attendance, experiences, and identifying details private. I may discuss my own experience while protecting others’ identities.No recording or captureI will avoid recordings, screenshots, photographs, saved transcripts, and AI meeting assistants. I will keep group discussions and chat content within the group.Participate in a private spaceI will take reasonable steps to prevent others from overhearing or watching, including using headphones when needed. I will let the facilitator know if privacy becomes difficult.Keep meeting access privateI will keep meeting links, IDs, and passcodes private and direct interested people to Michael for access.Respect choice and dignityI will respect others, allow time for everyone, and share only what I feel comfortable sharing. I understand that participants may listen or pass on any question.Understand the peer-support settingI understand that this group offers shared experience and mutual support. Medical treatment, psychotherapy, and crisis care belong with appropriate qualified providers or services.Understand confidentiality limitsI understand that privacy depends on every participant’s conduct and cannot be guaranteed. Organizers may share the minimum necessary information when required by law or when seeking help for a serious, immediate safety concern.Respect the group’s boundariesI understand that organizers may end participation or remove someone from a meeting or the group for privacy violations, disruption, or behavior that compromises safety.

Your acknowledgmentFull nameEmail addressTyped signature

Type your full name exactly as entered above to acknowledge these commitments. The date and time will be included in your prepared email.

Your completed acknowledgment is prepared in your browser and included in an email draft. Click Send in your email app to deliver it to Michael@lifeaftericu.org. Please leave medical histories and sensitive personal details out of this form.

Participant Agreement & Confidentiality Acknowledgment

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