Community Outing & Liability Consent

I, the undersigned parent or legal guardian of the child identified below, hereby grant permission for Raven Behavior Analysis to conduct Applied Behavior Analysis (ABA) therapy sessions in community settings as part of my child's individualized treatment plan.

I understand that community-based sessions are an integral part of ABA therapy, allowing my child to practice and generalize skills in natural environments. These outings will be designed by a Board Certified Behavior Analyst (BCBA) and carried out by trained Registered Behavior Technicians (RBTs) in accordance with each participant's individualized treatment plan.

This consent is specific to the child named in this form and does not extend to any other individual.

I authorize Raven Behavior Analysis staff to walk with my child to and from approved community outing locations during therapy sessions.

I understand that transportation will only occur as specified in my child's treatment plan and that staff will follow all safety protocols while walking in the community.

I understand that community outings involve inherent risks, including but not limited to: exposure to weather conditions, interaction with the public, traffic, uneven terrain, and other environmental hazards.

I acknowledge that while Raven Behavior Analysis staff will take reasonable precautions to ensure my child's safety, these risks cannot be entirely eliminated. I voluntarily assume all risks associated with my child's participation in community-based ABA sessions.

I, on behalf of myself, my child, and our heirs, hereby release and discharge Raven Behavior Analysis, its owners, employees, contractors, and agents from any and all claims, demands, or causes of action arising out of or in connection with my child's participation in community-based ABA services.

This release applies except to the extent caused by the gross negligence or willful misconduct of Raven Behavior Analysis.

In the event of a medical emergency during a community outing or therapy session, I authorize Raven Behavior Analysis staff to seek emergency medical treatment for my child, including calling 911 or transporting my child to the nearest emergency room.

I understand that I will be notified immediately of any such emergency and that I am responsible for any costs associated with emergency medical treatment.

Informed Consent: I understand that ABA therapy services are provided under the supervision of a Board Certified Behavior Analyst (BCBA) and that my child's treatment plan is individualized based on clinical assessment and ongoing data collection.

Voluntary Participation: I understand that participation in ABA therapy, including community-based sessions, is voluntary and that I have the right to withdraw consent at any time without affecting my child's eligibility for other services.

Medicaid Rights: If my child's services are funded through Medicaid, I understand that I retain all rights afforded to me under Medicaid, including the right to choose my provider, the right to receive services in the least restrictive environment, and the right to file a grievance or appeal.

Person-Centered: I understand that my child's treatment plan is designed around their individual needs, preferences, and goals, and that I will be included in the planning and review process.

Right to Revoke: I understand that I may revoke this consent at any time by submitting a written request to Raven Behavior Analysis, and that doing so will result in the discontinuation of community-based sessions.