Complete the Participant Information Form

1) I acknowledge that photographs will be taken during the session and agree to them being used in print and online (i.e. websites, Facebook, Instagram). If I do not agree I will advise facilitators. 2) I understand that the facilitators will not discuss what is said in the circle to anyone beyond the circle. The exceptions to confidentiality apply, which are: if the facilitator believes that a participant is at immediate risk of harming herself or someone else, and/or if a minor is a victim of physical or sexual abuse or neglect, or is a witness to a domestic violence or elder abuse. In these instances, the facilitator will need to follow the legal and ethical steps to assure safety to the participants.

At Blooming Girls, we offer a relaxing back massage activity using safe, handheld massage tools during closing circle as part of our wellness-focused programming. This activity is strictly optional, and each child is asked beforehand if they would like to participate. 1) Only the back area is massaged, with no contact to other parts of the body. 2) All massage tools are sanitized between uses. 3) Staff members conduct the activity in a professional and respectful manner.

*Release of Carrie Sheffield and Blooming Girls from Liability: In consideration of the permission granted by Carrie Sheffield and Blooming Girls(“Carrie Sheffield/Blooming Girls”) to enroll and participate in the Program, I do hereby release Carrie Sheffield/Blooming Girls and the employees, assigns, agents, heirs and members of the aforementioned, form all actions, causes of actions, damages, claims, or demands which I, my heirs, executors, administrators, or assigns may have against any and all aforementioned for any and all personal injuries, known or unknown, which I have or may incur by participation in the Program and for all damage to my property. I realize that there are inherent dangers and risks involved in the Program and I hereby agree to hold Carrie Sheffield/Blooming Girls and the employees, assigns, agents, heirs and members of the aforementioned harmless form any loss, liability, damage or cost that they may incur due to my enrollment or participation in the Program. I hereby agree to abide by any policies, rules and regulations adopted by Carrie Sheffield/Blooming Girls and understand that the violation of said policies, rules and regulations may result in immediate dismissal from the program without refund. I expressly agree that this release is intended to be as broad and inclusive as is permitted by the law of Colorado and that if any portion thereof is help invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect.  I further agree that should any dispute arise in connection with the Program that said dispute will be adjudicated in a court of competent jurisdiction in Larimer County Colorado.