TCTSY Consent/Waiver Form

TCTSY Consent/Waiver 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

Name *

First

Last

Name and phone number of Emergency Contact: *

By signing (typing) 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 to 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 (typing) and dating, I understand that yoga includes physical movements as well as an opportunity for physical and emotional relaxation, 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. *

Scope of Practice: While Kristen has a background as a School Psychologist with specific trainings and certifications in trauma work, at this time, Kristen's services do not include direct mental health therapy/support. 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 find mental health supports:

If you or someone you know is experiencing a mental health crisis, dial 988
Crisis support: text "HOME" to 741741 (www.crisistextline.org/texting-in)
Find a therapist: www.psychologytoday.com/us/therapists
LGBTQ-specific helpline: https://www.thetrevorproject.org/get-help/
Traverse City regional crisis support via NLCMH FAST Team: 1-833-295-0616
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 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.

TCTSY Consent/Waiver 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.