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My Village
Sign Up Form

Please Select 3 Workshops

Waiver & Parent/Guardian Permission

My Village was created to provide resiliency and strength building skills for teens in middle and high school (ages 12-18). Each workshop has been designed to promote connections with other peers and trusted adults and give teens tools to help manage big emotions of anger, anxiety, sadness, and stress. The workshops are being provided by community individuals and professionals that bring years of experience. Each workshop has been created to provide youth empowerment, strength building, connections, skills to help them build resiliency and tools to manage emotions and stress. Parent/Guardian permission is required for participation.

MY VILLAGE goal is to provide a safe inclusive environment for all participants. The Brian ONeill Jr Foundation will make every effort to ensure the safety of each participant and individual. At the same time, we expect that each participant/individual will show respect to the property, providers, volunteers, and their peers while participating in the workshops.

MY VILLAGE is not a replacement for therapy or counseling, but discussions may take place related to personal stories and experiences. It is important that personal stories shared in the workshops are not shared outside of the workshop. We will have trained adults available if a participant or individual needs extra support. If an individual or participant shares information that indicates, they are at risk for harm to themselves or others this information will be reported to the parent or guardian. It is the guardian’s responsibility to reach out to MY VILLAGE staff to discuss any special needs that may impact participation and ability to engage without becoming a distraction or danger to self or others.

Release and Waiver

I have read (or had read to me) the contents of this waiver/permission form and been given the opportunity to ask questions and to receive answers. I hereby release and discharge The Brian ONeill Jr Foundation and its directors, officers, employees, affiliates, members, agents, volunteers, and representatives, of and from all liability for any claims, demands, losses or damages, incurred by me or my child in connection with any aspect of this event. I further authorize and consent to the use of any materials, whether by videotape, film, newsprint, written advertisement, or otherwise, containing mine or my child’s name or picture, and I release The Brian ONeill Jr Foundation and its directors, officers, employees, affiliates, members, agents, volunteers and representatives from any claims I might have due to initial or subsequent publication of any such materials.

I agree for my child

to participate in My Village that is being hosted by Brian ONeill Jr. Foundation

A 25$ Donation is requested to attend My Village. But no child will be turned away for financial reasons. Please select request sponsorship if financial assistance is needed

Donation Options

After Registering, you will be redirected to your selected donation option

Please select 3 Workshops

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