TCTSY Consent/Waiver Form

TCTSY Consent/Waiver to Participate Form:
This form is confidential and will be sent directly to Kristen's secure email. Completed after intake and prior to starting the first TCTSY session. Please visit and read SSY's Policies and Scope of Practice page, and reach out with any clarifying questions.

* Indicates required field

Emergency Contact: Name/phone number *

By signing and dating, I am consenting to participate in Trauma Center Trauma Sensitive Yoga (TCTSY) via Stillness and Strength Yoga, LLC/Kristen Ryder, TCTSY-F. I understand that my participation in TCTSY does not replace psychotherapy, but rather serves as an adjunct/support to my primary mental health supports and/or any and all other medically-necessitated interventions. *

By signing and dating, I understand that yoga includes physical movements as well as the potential for physical and emotional shifts, stress reduction, and relief of muscular tension. As is the case with any physical activity, the risk of injury is always present and cannot be entirely eliminated. If I experience distressing physical or emotional pain or discomfort, I will pause/stop and adjust the posture/return to any comfortable body position, request support, and/or choose to stop practice. *

TCTSY and oncology yoga facilitation via Stillness and Strength Yoga, LLC, is exclusive to Kristen's training as a yoga instructor. Yoga Facilitators and clients work together to create a practice that is safe and manageable for the client. Please sign (type) and date below that you have reviewed the current SSY Policies and Scope of Practice page (link in subtitle), and all information is acknowledged and understood. *

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How to connect with mental health supports:

MI Warm Line: Peer mental health support specialists: 7 days a week 10am-2am: 1-888-733-7753
LGBTQ-specific helpline: https://www.thetrevorproject.org/get-help/
In a mental health crisis (you or someone else): dial or text 988
In need of crisis support: text "HOME" to 741741 (www.crisistextline.org/texting-in)
Traverse City regional crisis support via NLCMH FAST Team: 1-833-295-0616
Munson Intensive Outpatient/Partial Hospitalization Program: Call 231-935-6880 or Click HERE
PineRest Psychiatric Urgent Care Grand Rapids: Click Here or dial 616-455-9200
If you or someone you know is in immediate danger of hurting themselves or others, call 911 or go to the nearest emergency room
Find a therapist: www.psychologytoday.com/us/therapists
Michigan Black Therapy Fund: https://www.miblacktherapyfund.org
OK2SAY (click here for live link): Anyone can report tips confidentially on criminal activities or potential harm directed at students, school employees, or schools. Tips can be submitted 24/7

TCTSY Consent/Waiver to Participate Form:This form is confidential and will be sent directly to Kristen's secure email. Completed after intake and prior to starting the first TCTSY session. Please visit and read SSY's Policies and Scope of Practice page, and reach out with any clarifying questions.