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Find your Guide
Pre-Check
Please confirm together. Parent and young person:
The young person is between 12 and 17 years old.
No acute mental health crisis.
Sober. No alcohol, no drugs.
No severe mental health condition without professional supervision.
The young person wants to participate.
Parent Confirmation
I have read this together with my child.
The topic of touch has been discussed.
I allow participation.
I understand that my Guide works independently and on their own responsibility, not on behalf of FIVE MOVES®.
Youth Confirmation
I understand what will happen.
I want to participate myself.
I know I can say stop at any time.
Young Person
With our signatures we confirm all checked points.
Place, Date
Signature
Parent/Guardian
Place, Date
Signature
Guide
Name
Signature
Guide Only
Session Type
Date
Parent Present?
Note