CIC Interfaith Digital Dialogue Registration Form

CIC Interfaith Digital Dialogue Registration Form

Given the necessity of social distancing during the summer of 2020, CIC aims to continue its goals of increasing religious literacy, building empathy, and facilitating interfaith encounters through the CIC Interfaith Digital Dialogues. This program pairs interested participants with peers from another faith tradition in order to have a virtual “coffee date” and get to learn about one another’s faith traditions. By signing up, you are indicating your interest in being paired with a peer for conversations about your religious traditions. Anyone is welcome to participate in this dialogue, but minors require parental permission.
*The information shared will only be used for the purpose of this virtual dialogue program. The CIC will retain this information for the protection of all participant and reserves the right to release this information to the proper authorities if any participants violates the terms and condition below.
Contact Information

All fields marked with asterisks must be completed. Incomplete forms will not be processed.
Name - For the protection of all users, pseudonyms/fake names may not be used. *

First Name Last Name
Age *
If you check this box, your parent/guardian will have to sign the permission below.

I am a minor (Under the age of 17)
Gender

Male Female Non-Bianary Other
Phone Number
Email Address - At which you would like to be contacted by your dialogue partner. By sharing the email address you are giving CIC permission to share it with others who sign up to participate in the Interfaith Digital Dialogues program. *
example@example.com
Address (Only for the CIC, will not be shared publicly.) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How would you define your current RELIGIOUS IDENTIFICATION? *
Please indicate how many CIC programs you have attended in the past (including Festival of Faiths, CIC Banquet, lectures, service programs, etc.)? *

None. This is my first CIC program 1 - 3 4 - 6 7+
Please share any additional information that would help us pair you with discussion partners and make your experience as a participant in Interfaith Digital Dialogues positive.
How did you learn about this program?

CIC Facebook Twitter Instagram Search Engine Personal Religious Commmunity Referral Other
Signature (By signing here you agree to the Terms & Conditions as stated below.)
Type your name
Date *

Month Day Year
Date
Parent/Guardian Details

(Only needs to be completed if you are under 18 years old)
Parent/Guardian Name

First Name Last Name
Phone Number
Relationship
Parent/Guardian Signature (By signing here you agree to the Terms & Conditions as stated below for your minor child.)
Type your name
Date

Month Day Year
Date
Terms & Conditions
In order to promote a positive experience for participants in CIC Digital Dialogues, we want to make sure that all people who register have read the program description, understand the dialogue norms, and are committed to engage in honest, well-intentioned interfaith dialogue.

Unacceptable use:

1.     Giving out personal information about another person, including home address and phone number, is strictly prohibited.

2.     Hate speech that encourages physical harm of any kind to an individual or group, harassment, discriminatory remarks, and other anti-social behaviors are prohibited on the virtual dialogue.

3.     Communication which is defamatory, inaccurate, obscene, profane, offensive or sexually oriented is strictly prohibited.

4.     Use of the virtual dialogue for any unlawful purpose is prohibited.

5.     Virtual dialogue is for education and genuine dialogue. It is not a forum for criticizing the religious beliefs of anyone.

Disclaimer:

1.     The CIC cannot be held accountable for the information exchanged via this virtual dialogue.

2.     The CIC will not be responsible for any incidental, special, consequential or indirect damages suffered by any user. Users are advised to terminate any communication where they feel uncomfortable.

3.     The CIC makes no warranties (expressed or implied) with respect to the use of this virtual dialogue.

4.     The CIC reserves the right to change its policies and rules at any time.

User Agreement (to be accepted by all adult users and parents/guardians of students under age 18.)
I have read, understand, and will abide by the above CIC Digital Dialogue Policies. I further understand that any violation of the policies above is unethical and may constitute a criminal offense. Should I commit any violation, my access to the digital dialogues may be revoked, and/or appropriate legal action may be initiated. I further agree that I will not hold the CIC responsible for any offensive comments or harm that occurs on this virtual dialogue.
Terms and Conditions Acknowledgement *

By checking this box, I accept the Terms & Conditions of the Virtual Digital Dialogue Program.
As parent or guardian of the child, I have read the Acceptable User Agreement and will monitor my child to assure that they abide by the CIC Digital Dialogue Policies. I understand that this access is designed for educational and religious dialogue purposes. CIC has taken reasonable steps to control use of this virtual dialogue, but cannot guarantee that the content of dialogue will be appropriate to student users. I agree that I will not hold the CIC responsible for the dialogue that occurs on this virtual dialogue. Further, I accept full responsibility for my child's use of this digital dialogue. I hereby give permission for my child to use CIC’s Digital Dialogue.
Terms and Conditions Acknowledgement

By checking this box, I affirm that I am the parent/guardian of the child above and I accept the Terms & Conditions of the Virtual Dialogue Program.
Thank you for your interest in CIC's Interfaith Digital Dialogues program. If you have any questions or would like to share more information with us prior to participating in the program, please contact Allison Bishop at allison@centerforinterfaithcooperation.org.
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CIC Interfaith Digital Dialogue Registration Form

Contact Information

Parent/Guardian Details

Terms & Conditions