Safe Space Salina Agreement

Safe Space Salina Agreement

Please read and agree to our pledge to promote inclusivity and support for all individuals. By submitting this form, your business commits to our values and will display our inclusive decal.
Business Name*
Full Name of Business Representative*

First NameLast Name
Phone Number
Please enter a valid phone number.
Address of Business *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address of Business Representative*
example@example.com
Safe Space Salina Pledge:

• Welcoming all people regardless of gender identity, sexual orientation, race, religion, ability, or background.

• Ensuring our entire team understands and supports these values — so every person who walks through our doors receives the same safe and respectful experience.

• Committing to ongoing growth around inclusion and equity.

• Creating a space where people can be their authentic selves.
Agreement to Pledge and Support*

I agree to uphold the values of inclusivity and respect as outlined in the pledge.I agree to display the decal in my business location.
Please allow up to 30 business days for us to deliver your window decal or you can pick your decal up at Poppy & Vine, 108 S Santa Fe, Downtown Salina after you complete this form.
Digital Signature of Business Representative*

Powered by Jotform SignClear
Should be Empty: