SafeSpace

Confidentiality Agreement

This is the confidentiality & hold harmless agreement for Wolves Rise Virtual Experience as pertaining to the blog, zooms, or any in person meet ups.

Check each box to indicate that you have read it and agree. *

I am an adult I am the parent/guardian of the minor named below. I give my permission for the minor to participate. I voluntarily request permission to participate in Wolves Rise Virtual/In Person Book Club, fitness activities, workshops and classes led, assisted, provided, or facilitated by Pink Moon Belly Dance/Rites of Passage Institute. I do herby fully release and discharge Rites of Passage Institute and their agents, employees and sponsors, and those whose facilities are being used (the “Released Parties”) from any and all liability, claims, and causes of action, including negligence, for injuries or illness (including death), damages, or loss which I may have or which may accrue to me on account of participation in the activities mentioned above. This is a complete and irrevocable release and waiver of liability. I covenant not to sue the Released Parties for any alleged liabilities, claims, or causes of action released hereunder.

As part of the Wolves Rise Book Club/Blog/Virtual/In Person Experience, I'm aware that I may be exposed to information concerning individuals that is of a personal and confidential nature. I agree that this information will not be disclosed to any third party (no copy paste or screenshots for privacy of member). Also, the Wolves Rise Blog Posts are the intellectual property of Rites of Passage Institute/Shemora Sheikh copyright laws apply. *

I Agree I Do Not Agree

Do You Want to Recommend someone for Wolves Rise? *

Yes No Maybe

If you want to recommend someone, please provide her name, number, and email. If you do not provide the information for me to contact the person, then I will call you for the information. *

Why do you recommend this sister? *

Your Information:

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Name *

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Name of Minor *

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Signature *

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Comments, Suggestions, Questions? *

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Creating Safe Space

Confidentiality Agreement

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