Forms

Thank you for your time and effort to complete one or more of the forms below.

The colonial government of the U.S. has white supremacist practices that could be used against the intentions and services of Brown Girl Healing LLC and nonprofit (BGH) around liabilities pertaining to safety, injury, etc. The forms below are basic steps that we take to navigate those practices.

If you have questions about the forms, please contact us at Contact@BrownGirlHealing.org.

Yakoke. Wado.

Health Waiver

Brown Girl Healing LLC and the nonprofit (BGH) are not responsible for your health and wellbeing. This basic health waiver form confirms that you understand who does and does not hold liability for your experiences in health and wellness activities with BGH.

RELEASE OF LIABILITY
In order to participate in any and all health and wellness activities with BGH, you are releasing and agreeing not to sue Brown Girl Healing LLC and the nonprofit (BGH) or its officers, directors, employees, sub-contractors, sponsors, agents, and affiliates (“All of Us”) from all present and future claims about personal injury.

Signing below means the following:

“I understand and agree that Brown Girl Healing LLC and the nonprofit (BGH) are not responsible for any injury or property damage arising out of participation in any and all activities, even if caused by their ordinary negligence or otherwise. I understand that participation in any and all activities involves certain risks, including, but not limited to, injury. I am voluntarily participating in any and all activities with knowledge of the risk involved and I agree to accept all risks of participation.

I also agree to indemnify and hold harmless Brown Girl Healing LLC and the nonprofit (BGH) for all claims arising out of my participation in any and all activities. I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state in which any and all activities take place and agree that if any portion of this Health Waiver is invalid, the remainder will continue in full legal force and effect. I also acknowledge that BGH has not arranged and do not carry any insurance of any kind for my benefit or that of my parents, guardians, trustees, heirs, executors, administrators, successors, and assigns.

I represent that, to my knowledge, I am in good health and suffer no physical impairment that would or should prevent my participation in any and all activities. I also understand that this document is a contract which grants certain rights to and eliminates the liability of Brown Girl Healing LLC and the nonprofit (BGH).”

If you have any reflections or questions, please connect with us at Contact@BROWNGIRLHEALING.org and BROWNGIRLHEALING.org

Name

First

Last

Name of organization that you are representing

Are you a legal minor under 18-years old?

Yes

If yes, what is the first and last name of your legal guardian?

Phone

Name of Emergency Contact

Emergency Contact Relationship to You

Phone number for Emergency Contact

Signature

Clear

Signature of minor's legal guardian

Clear

If you are human, leave this field blank.

Legal Care of Minors

As the designated representative of your organization, whether or not you hold a legal discretionary role in the organization, you acknowledge that youth participants who are engaging in Brown Girl Healing LLC and nonprofit (BGH) activities are under the legal care of your organization. Further, you acknowledge that legal guardians of the minors have given your organization direct or overt permission for the youth to participate in any and all activities. If an emergency situation arises with any of the minors under your organization's legal care, you have the appropriate protocols to respond.

Name

First

Last

Your role or title in the organization

Name of organization that you are representing

Phone

First and Last Name and Date of Birth for all participating minors

Signature

Clear

If you are human, leave this field blank.