Your first and last name

I agree to be a part of cultivating a positive and respectful atmosphere during our group meetings!
I will speak respectfully regarding all others without offensive language, even when they are not in the room.
If I have a concern with someone in the group, I will discuss it privately with the group leader.
I will keep my cell phone silenced and put away during the meetings (unless I have an urgent call coming in).
I will make it a priority to be at our scheduled meetings!
*We value your input!

I acknowledge that Dakota Family Solutions is a faith-based organization. We believe spirituality is a positive aspect of life!
*DFS is very careful to respect everyone no matter where they are on their spiritual journey!

I am committed to keeping others in the EMBER Program healthy by NOT attending if I am or my child/children are sick (fever/covid/vomiting/diarrhea/etc). We want to spread our love, not our germs to others!

We work hard to make our groups a safe place where you can share and be heard! In light of that, will you agree to keep all personal information in confidence, that is shared in any DFS group you are involved with? *Mandated reporting will apply if necessary. That means as leaders, we have to report circumstances where people's safety may be at risk.

I understand that Dakota Family Solutions cannot provide emergency services. If I am struggling with thoughts of self-harm or harm to others, I can: call 911 (physical emergency); call/text 988 (mental health hotline); present to the Emergency Department at the local hospital.

In case of an emergency while you/your children are in attendance at any Dakota Family Solutions programming, please provide us with a full name and phone number of someone we could contact on your behalf.

Please list each child you may have with you for any Dakota Family Solutions programming using this format:
Child #1: Name/Gender/Age  
Child #2: Name/Gender/Age  
*Simply put N/A if you will not have children with you.

I understand that Dakota Family Solutions does NOT provide direct childcare. Therefore, I am ALWAYS fully responsible for children with me when they are in attendance at ANY DFS programming (such as for special events/playgroup). I understand that I am solely responsible for any injuries/illness/accidents that may occur during my/my child's/children's attendance at any DFS programming. By saying Yes on this form, I hereby assume, on behalf of my child/children/myself, all risk of injury, illness or loss to which my child/children/myself may be exposed. On the occasion that another entity partners with us for an event/weekly programming, they may offer childcare; you will have the opportunity to make arrangements with them regarding your child/children.

*Even if you do not have children registered, this release covers you individually as well, so please respond to this release. Thank you!

Please type your name here as your signature for this form. Thank you!

Please include any questions or comments you have here. Thanks.
We look forward to learning and growing together!