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WHO WE ARE
Our Team
News & Press Releases
Community Connections
Media Kit
Contact Us
TRAINING & CLASSES
Adults
Youth
Organizational Workshops
Restorative Practices
Training Options for Schools
Training Options for Individuals
Restorative Parenting
Restorative Denver Training
Register for a Class
PROGRAMS
COMMUNITY PROGRAMS
Rethinking Conflict: Youth Class
Restorative Denver/Restorative Justice
Restoring Peace: Practical Tools for Parents and Families
SCHOOL PROGRAMS
Hot Spot Mapping
Rethinking Conflict: Youth Class
Building Healthy Relationships/Social Norming
Reading for Peace
RESTORATIVE PRACTICES
Training Options for Schools
Training Options for Individuals
RESOURCES
Original Resources
Blog
Annual Report & Financials
Restorative Resource Directory
GET INVOLVED
Donate
Youth Advisory Board
Become a Volunteer
Become an Instructor
Internship Program
Community Events
Join Our Team
“In Your Element” Skills Auction
DONATE NOW
Restoring Responsible Gun Use Thematic Process: Person Who Caused Harm Survey
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Full Name:
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Email
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Enter Email
Confirm Email
RRGU Case ID Number: (No symbols, numbers only)
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Today's Date
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MM slash DD slash YYYY
I need to complete
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Pre-Conference Paperwork
Post-Conference Survey
Release of Liability and Responsibility
Release of Liability and Responsibility
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By checking this box, I have read and agree to the statement below...
I understand the agreements stipulated in the contract may involve some activities with unforeseeable risks of accidental injury or illness.
I understand that in the event of any type of accident, injury, or illness, I accept responsibility for all expenses associated with the accident, injury, or illness. I also accept responsibility for any type of property damage or violation of the law incurred or committed while performing these activities.
I do hereby release all the participants, facilitators, employees, volunteers, and sponsors of The Conflict Center from any responsibility and liability resulting from any unforeseeable accident, injury, or illness, property damage, or any other violation of the law.
I will defend and indemnify any of The Conflict Center employees or affiliates from a claim by any other party as a result of unforeseeable accident, injury, or illness, property damage, or any other violation of the law.
I certify that my consent has been intelligently and voluntarily given and I have read all the terms of the above as a release from liability.
Please type your name in the box below. This will serve as your signature that you agree to the above "Release of Liability and Responsibility" statement.
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Date
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MM slash DD slash YYYY
Statement of Understanding in Order to Enter Restorative Denver Program
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By checking this box, I have read and agree to the statement below...
I also understand the importance of being truthful throughout the restorative justice process.
By entering the Restorative Denver’s Restoring Responsible Gun Use program I agree to participate in an intake interview, a pre-conference interview, and a Circle Process at The Conflict Center.. I understand that I must be open and honest throughout the process and explore the effects of my actions on all participants in the Community Circle. I am also willing to complete the Restoring Responsible Gun Use agreement that I will participate in creating during the Community CIrcle.
I understand the fees for participation are tiered as follows and I will pay fees prior to participation if possible:
No fee if indigent and represented by the public defender
$125 if represented by private counsel with proof of public assistance
$250 with private counsel
Payment prior to Community Circle is preferred; however, payment is required before contract completion
Payment can be made online at: https://conflictcenter.org/restorative-denver-payment/
or by check or cash (option for installments)
I understand that it is my responsibility to stay in contact with The Conflict Center staff in order to assure that I have all dates, times, and locations for all pre-conference, circle, and contract completion.
In the event that I do not complete the program, I understand that a Notice of Unsuccessful Completion will be sent to the District Attorney’s Office and that my case will be returned to the court process. I also understand that the Denver District Attorney’s Confidentiality Proclamation protects anything I say during the screening meeting and throughout the restorative justice process from being used against me in current or future criminal proceedings. I further understand that if I engage in conduct during any part of the restorative justice process that results in a chargeable offense, that conduct is not protected by confidentiality.
I understand that if I successfully attend pre-conference and conference meetings and complete my contract, which includes having turned in all verification and assignments to the office, this case will be dismissed.
Please type your name in the box below. This will serve as your signature that you agree to the above "Statement of Understanding".
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Date
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MM slash DD slash YYYY
Confidentiality Agreement
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By checking this box, I have read and agree to the statement below...
The Conflict Center (TCC) as part of Restorative Denver requests that you sign this Confidentiality Agreement prior to participating in the pre-conference and circle process. All participants in the Community Circle are asked to keep confidential the names and identifying information of those directly involved.
Through this agreement, TCC is acknowledging the person who caused harm and community participants that the six basic principles of Restorative Justice—repair of harm to persons harmed, reconciliation of relationships, reintegration into the community, responsibility for actions, restitution to persons who were harmed, and respect for all participants—are paramount to the Community Circle process. Hence, a confidential environment is necessary to promote open communication between the person who caused harm, and the community.
Specifically for the person who caused harm (the defendant), the Denver District Attorney’s Confidentiality Proclamation protects anything said during the screening meeting and throughout the restorative justice process from being used against you in current or future criminal proceedings. Conduct that occurs during any part of the restorative justice process that results in a chargeable offense is not protected.
By signing this form, you are acknowledging the importance of confidentiality to the restorative justice process. Additionally, you acknowledge that you have read, understand, and agree to make every effort to maintain the confidential nature of these processes.
Should this Confidentiality Agreement be ignored by a participant, TCC will not be held responsible for the action of any individual. Violation of this request will be considered in determining participation in future Restorative Justice processes.
Please type your name in the box below. This will serve as your signature that you agree to the above "Confidentiality Agreement".
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Date
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MM slash DD slash YYYY
Please answer the following questions by circling the number that best describes how you feel right now on a scale of 1 to 7. Please answer as honestly as possible.
1. Right now, how do you feel about yourself?
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1 Awful
2
3
4
5
6
7 Happy with who I am
2. Right now, how do you feel about what you’ve done?
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1 It doesn't bother me at all
2
3
4
5
6
7 I can't stop thinking about it
3. Right now, how much do you worry about what other people think of you?
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1 It doesn't bother me at all
2
3
4
5
6
7 I can't stop thinking about it
For the most part, how much do you agree with the following statements right now?
4. My offense harmed the community.
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1 Not at All
2
3
4
5
6
7 Very Badly
N/A (No Direct Victim)
5. My offense harmed my family.
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1 Not at All
2
3
4
5
6
7 Very Badly
6. My offense harmed me.
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1 Not at All
2
3
4
5
6
7 Very Badly
7. I have done something that needs to be made right.
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1 Not at All
2
3
4
5
6
7 Very Much
8. I feel like my community cares about me.
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1 Not at All
2
3
4
5
6
7 Very Much
9. My case is being handled fairly
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1 Not at All
2
3
4
5
6
7 Very Much
11. Restorative Denver's Restoring Responsible Gun Use staff and volunteers are treating me with respect.
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1 Not at All
2
3
4
5
6
7 Very Much
Thinking about the community group conference, how much do you agree with the following statements?
12. I felt prepared and ready.
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1 Not at All
2
3
4
5
6
7 Completely
13. I felt that the process was fair.
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1 Not at All
2
3
4
5
6
7 Completely
14. I felt comfortable expressing my true feelings during the process.
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1 Not at All
2
3
4
5
6
7 Completely
15. Others in the circle listened when I spoke.
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1 Not at All
2
3
4
5
6
7 Completely
16. Others in the circle were looking out for my best interests.
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1 Not at All
2
3
4
5
6
7 Completely
17. The agreement/contract will help repair the harm that has been caused.
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1 Not at All
2
3
4
5
6
7 Completely
Thank you for your time in helping us understand and improve this process in the future. Please answer a few more questions, with as much detail as you can.
Did you feel pressured to participate in Restorative Denver's Restoring Responsible Gun Use? If so, by whom?
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What did the facilitator do that was helpful during the circle?
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What did the facilitator do that was not helpful (or that was harmful) during the circle? What do you think your facilitator should do differently next time?
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What has changed for you, if anything, as a result of participating?
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How satisfied were you with the overall process?
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Very Satisfied
Somewhat Satisfied
Unsure
Somewhat Dissatisfied
Very Dissatisfied
Is there anything else you would like to say?
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Are you willing to talk about your experience with Restorative Denver in the future?
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Yes
Maybe
No
If so, please list how you would like to be contacted here:
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