Full Legal Name

Date of birth

Contact Phone

Email

Location of current residence:

Have you ever been convicted of a crime?
YesNo

Why do you want to become a Healing Hand for Child Liberation Foundation?

Please list all your websites and social media (web address or @)

Website

Instagram

Facebook

YouTube

TikTok

Linkedin

Other(s)? Please list

What services would you like to offer if you were a healing hand?

Have you had past experience working with a foundation or charity organization?

How many years of experience do you have offering this service?

Are you trauma informed?
YesNo

What year and where did you receive your training?

If you answered no, are you willing to get trained?
YesNo

Do you have a program that you have created offering your service?
YesNo

If you answered yes, what language is it in?

Also, provide a description of your program and/or a link of your program

What languages are you fluent in?

Choose how you would like to offer your services
Remote ProgramIn person at a safe houseCo-creting a retreatAll of the above

Is there anything you would like us to know about regarding this application:

If you have chosen to offer your services in person, co-creating a retreat or all of the above, fill out the questionnaire below:

Are you available, willing, or interested in traveling with our foundation to safe houses?
YesNo

If you replied yes, do you have a valid passport?
YesNo

Do you have any disabilities that would impede your ability to travel or work abroad?
YesNo

Propositions

1. If you are offering your program remotely, you are agreeing to allow Child Liberation Foundation to be an affiliate and give discounts of 50% to Child Liberation Foundation members.

2. Gift/donate their program either remotely or in person at one of our affiliated safe houses and/healing centers and we will be promoting and marketing your offerings.

3. Work with us to set up a retreat in which we can host and co-create a healing program with you and your offerings in one of our affiliated healing centers. We will take 50% of the proceeds to cover all inclusive costs for the participants and facilitators.

Do you agree with these propositions?
YesNo

Authorization:
I authorize the Child Liberation Foundation to conduct a background investigation as part of its selection process. I authorize and consent, without reservation to the retrieval of information that may include but is not limited to organizations, federal, state, or county level agencies, insurance sources, driving and criminal history. I certify that all of the statements and answers set forth on the application form are true and complete to the best of my knowledge. I understand that following my Healing Hands term should any statements or answers be found to be false or information has been omitted, such false statements or omissions will be just cause for termination of my Healing Hands term. I further acknowledge that the photocopy of the documents attached shall be valid and accepted with the same authority as the original. If retained by the above referenced organization this authorization will remain in effect throughout my Healing Hands term.

Initials:

Upload a photo of yourself and Driver’s License/Passport here

Attach certification(s)/license of practice