Participant Registration Form

This program is an educational, supportive, community-oriented youth program. Activities may include group discussion, reflection, mindfulness exercises, and guided conversation. I understand that the program will take place in a library meeting room and will be supervised by Liliana Barzola. I understand that this program is educational in nature and is intended to provide a respectful, low-key, and supportive environment for youth participants. Group Discussion and Sensitive Topics: I understand that the program may include group discussion and educational conversation. Some topics may be personal, emotional, or sensitive, depending on the program content and participant questions. Examples of possible topics may include: identity, friendships, family communication, stress, school experiences, community issues, civic engagement, technology, or other relevant topics. The organizer will make reasonable efforts to create a respectful and age-appropriate environment. However, I understand that participants may share personal opinions or experiences during group discussion. I understand that this program is not a substitute for counseling, therapy, medical care, legal advice, or crisis support. Behavior and Participation Expectations: I understand that my child is expected to participate respectfully, follow reasonable instructions from program staff, and treat other participants, staff, library property, and community members with care. I understand that the organizer may contact me or require my child to leave the program if my child’s behavior becomes unsafe, disruptive, or inconsistent with the purpose of the program. Assumption of Risk: I understand that this is a low-risk educational program, but participation may still involve ordinary risks, including minor accidents, emotional discomfort from discussion topics, or interactions with other participants. Permission for Emergency Medical Care: If I cannot be reached in an emergency, I give permission for Circle Keeper Training Staff to seek emergency medical care for my child, including calling 911, contacting emergency medical services, or arranging transportation to a medical facility if needed. I understand that every reasonable effort will be made to contact me as soon as possible. I understand that I am responsible for any medical costs or expenses related to emergency care for my child, to the extent permitted by law. I Release and Liliana Barzola, their agents, employees, successors and assigns, and their respective heirs, personal representative, affiliates, and any or all persons, liable or who might be claimed to be liable, whether or not here in named, none of whom admit any liability to the undersigned, from claims or liability arising from my child’s participation in the program, except in cases of gross negligence, willful misconduct, or other liability that cannot be waived under applicable law. d paste