Draft for review — nothing you enter is saved. This is the paper packet (workbook pages 5–7) rebuilt as a web form so you can click through it and tell me what to change. Yellow notes mark decisions I need from you.

Lutheran Indian Ministries Healing the Wounds of Trauma

Before Your Healing Group Begins

Step 1
Pre-Assessment
Step 2
Consent & Release
Step 3
About You
✓

That's the end of the draft.

Nothing was saved — this is a review copy only.

In the finished version this is where the participant would be confirmed for their group, and Roberta would see the completed packet in a staff review screen, the same way Tree of Life applications arrive now.

Step 1 of 3 · Pre-Assessment

There are no right answers here. This helps your facilitator understand where you're starting from, and lets us see what changes for you by the end.

Your comfort level right now

On a scale of 1 (least) to 10 (most).

Note — this is the measurable part These five ratings are asked again word-for-word at the end of the group. Collected on paper they mostly never come back, so nothing can be compared. Collected here, you get each person's before-and-after and a group average — which is exactly the kind of evidence a grant application asks for.

Step 2 of 3 · Consent & Release

Robert — this one needs your decision before it goes live The release text below is copied word-for-word from the paper form so you can see it in place. Two problems with it:

1. Some of it isn't about healing groups. It has participants assume "personal and property risk," directs them to "use equipment, machinery or supplies in the manner they are intended," and to follow "worksite sign-off orientations." That's language from a work-site volunteer waiver. We found another organisation's name buried in the Tree of Life release the same way.

2. LIM already has a different release on the website — the Video & Photo Release, with cleaner wording. If this goes up as-is we'd have two LIM releases saying different things.

I'd suggest one reviewed release used everywhere. Happy to draft it, but the wording should have your and probably a lawyer's sign-off, not mine.

Media Consent — Image & Video Permissions

I hereby grant a perpetual and irrevocable non-exclusive, worldwide, royalty-free right to Lutheran Indian Ministries to use, reproduce, publicly display, publicly perform and publish digital videos and photographs of me (the “Images”), including my image and likeness as depicted therein, and to identify me by first name and state in connection with the images, in its marketing and instructional materials, or in any other manner it sees fit to conduct, promote or otherwise inform or educate others about its programs, or for any other purpose that furthers the educational and charitable mission of Lutheran Indian Ministries. I understand that photographs and video taken at a public event do not require express permission. I waive my right to inspect or approve any finished versions of any images.

Release from Harm & Indemnification

I understand accepting this release is a condition of my participation in LIM events. I understand that this is a release of rights for myself, dependents and/or heirs, and I have carefully read and considered it before signing. I expressly release, indemnify and hold harmless Lutheran Indian Ministries and its directors, officers, employees, agents, licensees and assigns from any and all claims which I have or may have for invasion of privacy, right of publicity, defamation, copyright infringement, or any other cause of action arising out of the use, adaptation, reproduction, distribution, broadcast or exhibition of the images.

Participation in LIM events is a privilege. If that privilege is violated — failing to respect the rules or instructions, causing a disturbance, or disrupting an event — it may be withdrawn by LIM at its sole discretion.

Question — should photo consent be required? On paper all three are signed together, so declining photos looks like declining to attend. Given how personal these groups are, I'd suggest the harm release and the age statement are required, and photo consent is genuinely optional — a plain yes or no that changes nothing else. Roberta, is that right?
Typing your name is your electronic signature and covers the items you ticked above. Today's date is recorded automatically.
Note — one signature instead of three The paper form has three separate signature lines. Online, one signature plus the tick boxes records the same consent and is easier to follow. Say the word if you'd rather keep three.

Step 3 of 3 · About You

LIM uses this information for compliance reporting and to secure the funding that keeps these groups free. Your answers are kept confidential.

Flag — the paper form contradicts itself here It says the data is used “anonymously” but then asks for name, address, phone, email and date of birth. That isn't anonymous, and saying so could be a problem if a funder or a participant ever looks closely. Two honest options: say “reported in aggregate, never individually” (which is probably what's meant), or genuinely drop the identifying fields. I've used the first wording above — confirm it's accurate.
Note — we'd be asking some people the same thing twice Education level and race/ethnicity are already on the Tree of Life application. Anyone doing both types them twice. Worth deciding later whether returning participants skip this step.
Note — a small addition worth making “How did you learn about LIM” is the only place we'd ever find out whether the Feathr advertising is reaching real people. I added Instagram and TikTok and modernised Twitter. Worth adding “Saw an ad online” too, Jaylene?

Draft for review · rebuilt from the Healing the Wounds of Trauma workbook, pages 5–7.
See the post-assessment draft →