MORE, Inc.-Lived Experience Interviews (Pregnancy and Infant Loss 2022)
What Color Is Your Ribbon? -Pregnancy and Infant Loss 2022
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Email *
First Name *
Last Name *
Mobile Number *
Best method of contact: *
Do you consider yourself as one who is: *
Would you like for others who have been on the journey with you to be interviewed as well? If so, could you include their name, age, relation/experience?
Do you mind sharing a little bit about your story? 
Please note that we seek for this to be an empowering and authentic experience. So, please share your lived experience from your perspective with that understanding. Further, if you have any other ideas or thoughts as to how to make this experience more effective, please let us know! 💜
Please, let us know what your availability is to record.
The recording will be with Dr. Diandra Renée Gordon. The location will be given to you upon confirmation. Please let us know your best availability for this week. 
Monday
Tuesday
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Sunday
9- 10 am
10 am- 11 am
11 am - 12 pm
12pm- 1 pm
1 pm - 2 pm
2 pm- 3 pm
3 pm - 4 pm
4 pm - 5 pm
5 pm - 6 pm
6 pm - 7 pm
7 pm - 8 pm
8 pm- 9pm
By submitting this form, you agree to the following: *
I, the above listed Volunteer, desire to be a part of the project as a volunteer for MORE Inc. & Family Time Initiative, LLC and engage in the activities related to being a volunteer for a work project.     I hereby voluntarily, execute this Volunteer Waiver under the following terms: I, the Volunteer, release and hold harmless MORE Inc. & Family Time Initiative, LLC and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my volunteer work with MORE Inc. & Family Time Initiative, LLC. I understand that this Waiver discharges MORE Inc. & Family Time Initiative, LLC from any liability or claim that I, the Volunteer, may have against MORE Inc. & Family Time Initiative, LLC with respect to bodily injury, personal injury, illness, death, or property damage that may result from my participation on MORE Inc. & Family Time Initiative, LLC's work site. I also fully understand that MORE Inc. & Family Time Initiative, LLC does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance, in the event of injury, illness, death or property damage. I, the Volunteer, understand that I expressly waive any such claim for compensation or liability on the part of MORE Inc. & Family Time Initiative, LLC beyond what may be offered freely by the representative of MORE Inc. & Family Time Initiative, LLC in the event of such injury or medical expense. I hereby release MORE Inc. & Family Time Initiative, LLC from any claim whatsoever which arises or may arise in the future on account of any first aid treatment or other medical services that are conducted in connection with an emergency during my time with MORE Inc. & Family Time Initiative, LLC. I understand that my time with Habitat may include various activities that may be hazardous to me and I hereby expressly and specifically assume the risk of injury or harm in these activities and release MORE Inc. & Family Time Initiative, LLC from all liability for injury, illness, death, or property damage resulting from the activities of my time with MORE Inc. & Family Time Initiative, LLC. I grant unto MORE Inc. & Family Time Initiative, LLC all right, title, and interest in any and all photographic images and video or audio recordings that are made by MORE Inc. & Family Time Initiative, LLC during my work with MORE Inc. & Family Time Initiative, LLC, including, but not limited to, any royalties, proceeds, or other benefits that are derived from such photographs or recordings. I expressly agree that this Waiver is intended to be as broad and inclusive as permitted by the laws of the State of Ohio in the United States of America, and that this Waiver shall be governed by and interpreted in accordance with the laws of the State of Ohio. I agree that in the event that any clause or provision of this Waiver shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
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