Best Friends Forever Parental/Guardian Consent

TITLE OF THE PROGRAM: Best Friends Forever (BFF) Project NAME OF INTERVENTION: Sisters Informing Healing Living and Empowering (SiHLE) INTRODUCTION The BFF Project is a five year project which utilizes the SiHLE intervention, a social-skills training intervention aimed at reducing HIV sexual risk behavior among African American teenage females ages 14-18. The sessions are gender-specific and culturally relevant and include practicing behavioral skills such as assertive communication, group discussions, lectures, role-playing, and take-home exercises. PROCEDURE AND DURATION OF THE INTERVENTION The SiHLE intervention will be conducted over the course of a two-day retreat. Participants will attend a four-session health education program that discusses dating, relationships, pride in being an African American female, and HIV prevention. Each session is approximately three (3) hours long. SiHLE activities will involve being in a group with 11 other teenage females ages 14-18. The group will be led by three African American female facilitators, two of which are near aged peers of the participants. INTERVENTION LOCATION SITE Duncan Gray Conference Center in Canton, Mississippi will serve as the intervention site. Cottages at Duncan Gray will be utilized for sleeping arrangements and training activities. The cottages include eight (8) sleeping rooms with two (2) separate beds per room and a private bath per room. All bed and bath linens are provided. Participants will select roommates from among other participants. The common gathering area of the cottage will serve as the training space. Duncan Gray Conference Center will provide dinner on the day of arrival and breakfast and lunch on the day of departure. TRANSPORTATION & MEDICAL LIABILITY WAVIER

As a parent/guardian of the undersigned minor participant, I hereby consent and agree to hold harmless, My Brothers Keeper, Inc. of Ridgeland, Mississippi and any and all employees or volunteers thereof, for any accident, injury or occurrence arising out of, or in connection with the activity and arranged transportation necessary to participate in the aforementioned activity. I understand that my child/ward will be assigned to ride with a licensed adult driver, driving a privately-owned and/or rented automobile and that this assignment will be made by the aforementioned organization. I give my permission for my child/ward, in case of an emergency, to be taken to a physician or hospital by a My Brothers Keeper, Inc. staff member. I understand that every effort will be made to contact me. If I cannot be reached, I hereby give permission to the physician selected by the staff member in charge to secure proper treatment for my child/ward.
My Brothers Keeper, Inc. BFF Project Intervention Consent Form Form 5

GIFTS AND REWARDS The participant will receive several incentives throughout the course of the program, such as follow-up sessions, reunion sessions, small gifts, transportation to and from the intervention site and meals. Additionally, a monetary stipend will be provided upon completion of all four sessions. RIGHTS DURING THE PROGRAM Participation in this program is voluntary. Participants are free to withdraw (stop participation) at any time without giving a reason. If a participant ends participation during the retreat phase of the program, return travel arrangements will be the responsibility of the parent/guardian at that time. The parent/guardian of the participant will have to travel to Duncan Gray within two (2) hours of the participant withdrawing from participation. PARENTAL/GUARDIAN CONSENT I hereby confirm that I have been informed by the Project Coordinator about the nature and purpose of the BFF Project and SiHLE intervention retreat. I have also received, read, and understand the above written information (Best Friends Forever Parental Consent Form) regarding the program. I have been allowed to ask questions and all questions have been answered. I understand that my signature below indicates that I consent to allow my child /ward to participate in the BFF Projects SiHLE intervention retreat. I also understand that my signature indicates that I will understand and will comply with all of the information outlined in this consent form. My signature below acknowledges that I have legal authority to sign on behalf of the below listed minor participant.

Project Coordinator:

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Printed Name Minor Participant:

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My Brothers Keeper, Inc. BFF Project Intervention Consent Form Form 5