ACT x Humanitas Counselling (Thandiwe)

Book your free counselling appointment

Please take note of the following:

As a client the counselling service you book is FREE and you may make use of 8 to 12 sessions with your counsellor.
Counselling services are ONLY open to artists, the creative sector and/or creative practitioners.
Duration for each counselling session is an hour.
Types of counselling services available: Trauma and emotional Wellbeing, Personal Development, Addiction and Crisis management counselling, Grief counselling, Life skill enhancement, Couple counselling and Life changes counselling.

ACT x Humanitas Counselling Registration (Thandiwe)

Name(Required)

First Last

Are you an artist?(Required)

Yes

Please specify your race.(Required)

Black African

White

Indian

Coloured

Other

Prefer not to specify

Please specify your gender.(Required)

Female

Male

Transgender

Cisgender

Non-binary

Prefer not to specify

Are you under the age of 18?(Required)

Yes, I am under the age of 18

Age(Required)

Which arts discipline do you specialise in?(Required)

Acting

Music

Dance

Choreography

Writing

Directing

Visual/Digital Arts

Other

You may select more than 1 x arts discipline.

If you selected 'other' in the previous question, kindly elaborate further.

Email(Required)

Cellphone number(Required)

WhatsApp number

Emergency person's name and surname(Required)

Emergency person cellphone number(Required)

Physical Address(Required)

Street Address Address Line 2 City Province ZIP / Postal Code

Reason for counselling request(Required)

Counselling Consent & Informed Agreement

Thank you for applying for counselling support. Please read and confirm the information below before submitting your application.

1. Counselling Services

This service provides emotional wellness support and counselling.

Please note:

Counselling is voluntary.
Counsellors cannot diagnose mental health conditions or provide court-related services.
Sessions may take place online via Microsoft Teams or WhatsApp Video Call.

2. Confidentiality

Your privacy is important to us. Information shared during counselling sessions will remain confidential unless:

There is a risk of harm to yourself or others.
Abuse or neglect is suspected towards a child, a disabled person, or an elderly person.
Disclosure is required by law.
Or you provide consent for information sharing.

3. POPIA Consent

By continuing, you consent to your personal information being:

Collected for counselling purposes only.
Stored securely and confidentially.
And processed in accordance with POPIA regulations.

4. Availability & Emergencies

Counselling support is available during working hours only and is not an emergency crisis service. If you are in immediate danger or experiencing a mental health emergency, please contact:

Emergency Services: 10177 or 112
SADAG: 0800 567 567
Childline South Africa: 116

5. Consent Agreement

Do you consent to the following:(Required)

I understand the counselling process and confidentiality limits

I consent to participate in counselling services

I confirm that the information provided in my application is accurate

I ACCEPT the counselling consent agreement and terms of service.

I DO NOT ACCEPT the counselling consent agreement and terms of service.

6. Digital Acknowledgement

This section serves as a digital signature of you providing consent.

Initials(Required)

Please list your initials

Full name (digital signature)(Required)

Date(Required)

MM slash DD slash YYYY

7. Parent/Guardian Consent (Under 18)

Only request for your parent/legal guardian to fill out this section if you are under the age of 18.

I confirm:(Required)

That I am the parent/legal guardian of the applicant and consent to counselling services.

Parent/Guardian's Initials(Required)

Parent/Guardian's Full Name (digital signature)(Required)

Date(Required)

MM slash DD slash YYYY

Non-eligibility

Thank you for your interest. Unfortunately, this opportunity is specifically intended for South African artists, it is not eligible for individuals outside the arts sector.

8. Protection of Personal Information Notice

We respect your privacy and intellectual property rights. All personal information and intellectual property submitted through this application form will be treated with the utmost confidentiality and will only be used for the purpose of facilitating the Humanitas counselling services. We are committed to complying with the provisions of the Protection of Personal Information Act (POPIA), ensuring that your personal information and intellectual property are not used illegally or in violation of copyright laws. By submitting your application, you consent to the processing of your personal information and acknowledge that it will be handled responsibly and in accordance with applicable laws and regulations.

I consent(Required)

Yes

Non-eligibility

Your application is considered ineligible for submission if you do not provide consent or a digital signature in the Counselling Consent & Informed Agreement section.