Registration for Everyone Counts Game Shows with Informed Consent for Completing this Form and Using the Wellness Weavers Cisco WebEx "Enterprise" Event Center Survey

... to tap into the STAR power of the Skills, Time & Talents, Affirmative Action Attitudes, and Resources of all citizens...the tax-payers, tax-consumers, volunteers, and the employees that work for pay and are carrying the debt.

CSR businesses that value the STAR power of individuals and the collective STAR power that keep the productivity, cash, and benefits flowing also deserve access to this new paradigm in support of employee engagement, innovation and the wellness needed for collaborative innovation.

If employers have employees or family members that are members of the Live Well Health and Wellness Cooperative system, then they are eligible to participate in-kind in at least on Everyone Counts Game Show. That requires completing this Registration tool.

Question Title

* 1. Please indicate the roles and as many categories as apply to your STAR power of Skills, Talents, Affirmative Action Attitudes, and Resources.

The more diverse representation we have, the better we all can win at our Everyone Counts mission.

If you don't find your role listed, you can add it in the comment section below.

EVENT PARTICIPANTS: I am a citizen of the USA or another country on this planet that can read, write, and understand the spoken English language.

I am a citizen with special needs and understand that it is my duty to work with the Wellness Weavers Everyone Counts Game Show Team to come up with a plan to accommodate my special need.

I am in a family with at least one member that graduated from a Headstart or PreK Quality Early Childhood Learning Center

I am in a family with at least one member with an Adverse Childhood Experience, PTSD, Mental Health or Substance Use Disorders

I am in a family with a member that has been incarcerated and has a Probation or Parole Officer

I am a candidate for an elected or appointed position of leadership

I am an elected city, county, state, or federal government official

I am the head or spokesperson for a govermental service agency

I am part of FEMA or a VOAD

I am a CEO or Director of Human Resources

I am a certified Educator

I am a Therapist that has been involved on a Multidisciplinary Team for the treatment of Mental Health, Substance Use Disorders, PTSD, or the dementias

The Quality of my Life has been greatly improved with a wholistic health and wellness plan though I was diagnosed with a chronic health issue

I am a Veteran or a family member of one

I am a Military Reservist or a family member of one

I am a Librarian or Professor at a state funded Medical or Law University

I am a civic leader that has attended a civil leadership course

I am a lifelong learner and skilled in connecting with the knowledge I seek

PARTNERING ENTITIES: Our company, institution, agency has a Cisco WebEx Training Center account

Our company, institution, agency has either a Cisco WebEx Event Center, Zoom, or GoToMeeting account

I am a Thought Leader and can spread the word via Social Media routes and Linked In Networks

I think this sounds like an excellent way to invest my money as a tax-deductible gift.

I can be very generous with my time, positive thoughts, and prayers in support of this mission.

EVENT PLANNING TEAM: I have a special need and will help the planning committee come up with a solution to accommodate it.

I have had experiences with facilitating large and small groups to learn with fun.

I am involved with people and organizations that use the best practices for healthy engagement of employees, volunteers, or citizens.

I have experience with leading play with the purpose of stress management for enlightenment, & innovation

I enjoy making events special in conjunction with National Health Observance themes

I have looked at the "Our Waterville Facilities" options that are available via the Wellness Weavers Website and have some ideas to creatively leverage those assets to raise funds for this overall mission.

Other (please specify)

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* 2. Indicate the best times of the day for you.

	Yes	Maybe
Times of the Day: Between 6-9 AM	Times of the Day: Between 6-9 AM Yes	Times of the Day: Between 6-9 AM Maybe
Between 9 AM-12 PM	Between 9 AM-12 PM Yes	Between 9 AM-12 PM Maybe
Noon Hour	Noon Hour Yes	Noon Hour Maybe
Between 1-3 PM	Between 1-3 PM Yes	Between 1-3 PM Maybe
Between 3-5 PM	Between 3-5 PM Yes	Between 3-5 PM Maybe
Between 5-7 PM	Between 5-7 PM Yes	Between 5-7 PM Maybe
Between 7-9 PM	Between 7-9 PM Yes	Between 7-9 PM Maybe

Please use GMT + or - number of hours.

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* 3. Indicate the best days of the week for meeting or event days.

	Yes	Maybe
Days of the Week: Mondays	Days of the Week: Mondays Yes	Days of the Week: Mondays Maybe
Tuesdays	Tuesdays Yes	Tuesdays Maybe
Wednesdays	Wednesdays Yes	Wednesdays Maybe
Thursdays	Thursdays Yes	Thursdays Maybe
Fridays	Fridays Yes	Fridays Maybe
Saturdays	Saturdays Yes	Saturdays Maybe
Sundays	Sundays Yes	Sundays Maybe

Please use GMT + or - number of hours.

Question Title

* 4. Indicate your time zone.

	Yes
My Time Zone: USA Pacific Time	My Time Zone: USA Pacific Time Yes
USA Mountain Time	USA Mountain Time Yes
USA Central Time	USA Central Time Yes
USA Eastern Time	USA Eastern Time Yes
Other Countries, please add Time Zone & largest urban area in your timezone in comments	Other Countries, please add Time Zone & largest urban area in your timezone in comments Yes

Please use GMT + or - number of hours.

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* 5. Complete your contact info to get into the communication loop. Your information will not be shared or sold to anyone else!

Name

Email Address

Phone Number

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* 6. I verify my son, daughter or the person that I am a court appointed Guardian for has my consent to participate in this project. I further verify that it is my responsibility to monitor their activities and safety. By filling out the contact information I give my consent and understand that it is recommended that I also register for my own involvement.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 7. "Conditions and Terms of Agreement" is the business term for the health care term "Informed Consent".

We want all participants that are on the Everyone Counts Game Show to be fully informed so that everyone can have a good and productive one-hour session.

To insure that your time and ours is not misappropriated, you must read and agree to each of the below statements.

Only people that agree to all the terms will be contacted to be participants on a future show.

I will tell only the truth on this line and all the boxes that I will check. I understand that I do have to check all the boxes to be on the first Everyone Counts Game Shows because we are learning what works and can only work with people that are willing to help everyone succeed in having their needs met.

If I have not joined the Event by 15 minutes prior to "take off", I understand that my seat may be filled with someone on the "Space Available Waiting List".

I understand the content of this registration process and verify my answers are honest for my involvement in the Everyone Counts web-based events and that I am of legal age and sound mind to give my own informed consent to be involved in this process.

I understand that it is my obligation to watch my emails from Messenger Cisco WebEx for the links to the Wellness Weavers Green STAR Ship Enterprise for the Everyone Counts Game Show that matches an available date and time when your Priority Seat is open.

I further understand that I have clicked on the link and read and agree to follow the Bee Attitudes as the Code of Conduct for any online or in-person sessions or events made possible by Wellness Weavers, Inc.

I understand that if I violate the Code and ignore the instructions of the Referee and the Panel of Peers, that I will be voted off the STAR Ship by the PeaceKeepers or escorted out of a live event site by a trained member of the active or retired military forces or civilian law enforcement system.

I understand that being escorted out of a session does not preclude becoming involved in a future event after a private meeting with a representative of Wellness Weavers to find out why I was having trouble living by the Bee Attitudes.

I have hope that finally every person finally will count and have their needs met because we will have opportunities for our needs to be expressed and have people help us come up with creative solutions for having them safely and legally met.

I understand that any session of Everyone Counts Game Show that I am a participant will also give me the opportunity to download and save a file of the episode within 24 hours with a window of opportunity to do so before the file is deleted.

I understand that Wellness Weavers, Inc is able to provide the use of their Cisco WebEx Enterprise Event Center only if they do not have to pay a fee to store the recordings of the shows.

"I think you need to consider adding....." (please specify)

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* 8. I am grateful for the opportunity to have a time when I, my family, friends, co-workers, elected officials or hired leaders can come together to experience equality and learn how to become the best version of Humankind.

I appreciate the team of people that are making this possible and am in a position to make a cash donation to help fund the technology, equipment, and utility bills that are involved in bringing this service to the people.