The undersigned, being the legal Custodian and Guardian of 

   
who has been placed at the House of Hope for Girls Program (hereinafter referred to as the “Program”), and the undersigned youth, have been informed that the Program does not use chemical or mechanical restraints. However, when absolutely necessary, we are trained and certified to perform therapeutic holds (using the MindSet approach) to prevent a participant from causing physical harm to themselves or others. If it is necessary to perform a therapeutic hold on a participant it is highly likely that that participant will have escalated to a point where they will need a higher level of structure than the Program can safely provide and the participant could be transferred to a psychiatric hospital for evaluation, if deemed necessary by the treatment team.

The undersigned have been informed that the Program is not, and will not, be the legal custodian and/or guardian of the participant and that the Program is not responsible for actions taken by the participant either while on or off the Program property. Furthermore, the undersigned have been informed that if the participant runs away from Program property or runs away while off Program property, the Program will call the local police department and will notify the undersigned Legal Custodian and/or Guardian. However, the Program will take no action to secure the return of the participant to the Program. The undersigned Guardian or Custodian must take action to return the participant to the Program.