For Participants 18+

Adult Intake & Waiver

For young women ages 18+ enrolling on your own. (If you're under 18, please use the parent waiver form instead.)

Your Information

Full name *Age *Email *Phone *

Emergency Contact

Someone we can reach in case of an emergency during a session.

Name *Phone *Relationship *

Allergies & Medical Notes

Allergies (food, environmental, medication)Write 'none' if not applicable.Other medical notes we should knowAnything that may affect participation (optional).

Photo & Media Permission

From time to time we take photos during sessions and circles for use on our website and social media. Faces are only used with consent.

I give permission for photos including me to be used in This Little Light Collective marketing and social media. (Optional — leave unchecked to opt out.)

Acknowledgements

Age confirmation. I confirm I am at least 18 years of age and am enrolling on my own behalf.Participation acknowledgement. I understand that participation in This Little Light Collective programs is voluntary, and I release the Collective, its facilitators, and host venues from liability for any incidental injury or loss that may occur during normal participation.This is mentorship & workshop-based, not therapy. I understand This Little Light Collective offers coaching, mentorship, and group workshops focused on resilience and confidence. It is not mental-health therapy, counseling, or medical care, and is not a substitute for treatment by a licensed professional. If I need clinical support, I am responsible for arranging it.Group agreements. I agree to participate with kindness and respect toward every member of the group, keep what is shared in the group confidential, stay present (phones away during sessions), and engage in good faith. I understand that conduct that harms the group may result in being asked to step away from the program.

Stay Connected

Yes, please add me to the email list for updates, resources, and notes from Allison. (Optional — unsubscribe anytime.)

Signature

Type your full name as your signature *Signed today, 7/22/2026