Participant Consent Form

Homepage – Participant Consent Form

Wellness Talk & Reflective Conversation Sessions

1. Purpose of the Session

The Empathy Place provides an online safe space where individuals can engage in authentic conversations about real-life experiences, emotional wellbeing, and personal growth. These sessions are facilitated by an entological coach and a psychologist licensed by the Ministry of
Health (Kenya). They are designed for wellness, reflection, and self-awareness — not as formal psychotherapy, counselling, or clinical diagnosis.

2. Nature of the Session

Each session lasts approximately one (1) hour and is conducted virtually via Microsoft Teams or a similar online platform. Participation is voluntary, and participants may choose to withdraw at any time without explanation or penalty. The facilitators will guide the conversation in a reflective and supportive manner, but no medical, psychiatric, or diagnostic services will be provided. The session link will be shared only after full payment has been received to confirm attendance and reserve your spot.

3. Confidentiality and Anonymity

All discussions are regarded as strictly confidential. Participants are encouraged to use first names only or pseudonyms to maintain privacy. Recording, screenshots, or distribution of any part of the session is strictly prohibited without prior written consent from all participants and facilitators. Facilitators may use general, non-identifiable reflections for awareness, research, or training purposes, but no personal details will be disclosed.

4. Ethical Boundaries

The Empathy Place is not a substitute for therapy, mental health treatment, or crisis intervention. Should a participant display signs requiring professional support, facilitators may recommend referral to a qualified mental health provider.

5. Limitation of Liability

By signing this form, you acknowledge that: You participate voluntarily and at your own discretion. The Empathy Place, its facilitators, partners, and affiliates will not be liable for any psychological distress, discomfort, or perceived harm arising during or after participation. The facilitators do not
assume legal responsibility for personal actions, decisions, or interpretations made by participants following the session.

6. Data Protection and Record Keeping

No personal data will be shared with third parties without written consent.

7. Participant Acknowledgement and Consent

By signing below, I confirm that I have read and understood the information above and that: I am participating voluntarily in The Empathy Place wellness talk session. I understand that the session is not formal therapy or counselling. I consent to participate under the conditions outlined above. I release The Empathy Place and its facilitators from any liability arising from my participation. I agree to maintain confidentiality and respect the privacy of other participants. I understand that my session link will be shared only once payment has been confirmed.

Name
Date / Time

By submitting this form, I confirm that I have read and understood the consent information and voluntarily agree to participate under the terms outlined by The Empathy Place.

Consent