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For Enrolled Participant

Consent to Participate in Circles of Peace (Updated Nov 2025)


What is Circles of Peace?

"Circles of Peace" is a program that helps address crime and harm to prevent it from happening again. It's different from the regular justice system. Instead of focusing on punishment, it looks at how the harm affected everyone involved and figures out ways to make things better.

Circles of Peace focuses on repairing the damage done, keeping everyone safe, and promoting healing. It's an alternative to the usual way of handling these things through the justice system.


Participation

I agree to take part in the Circles of Peace program in good faith. This means I will:

• Listen carefully and speak honestly.

• Treat others with respect.

• Participate in a process of healing, accountability and repair. I will sincerely attempt to resolve the impacts of harm meaningfully.

• Attend meetings regularly and stay in contact with program staff.

• Cooperate respectfully with circle keepers and follow their guidelines.


Program and Case Conditions

I understand that:

• If I commit a new crime or stop participating for more than 30 days, the State may take back my case.

• Six Rivers may also return my case to the State if Six Rivers finds the Circles of Peace process is no longer appropriate.

• My case may be returned to the State if I do not follow this Consent to Participate.


Voluntary Participation

I understand that joining Circles of Peace is voluntary. If I choose to leave, Six Rivers will return my case to the State. If I leave, I will tell Six Rivers in person or in writing. If I stop participating without telling them, Six Rivers will try three times within 30 days to contact me before returning my case to the State.


Circle Process

I understand that the circle keepers are committed to a process of healing, accountability, and repair. The restorative circle process is driven by the needs of those harmed. The circle keepers will do their best to ensure that everyone in the circle gets an opportunity to be fully heard. The circle keepers’ primary role is to facilitate a fair, voluntary process of healing, accountability, and repair.


No Legal or Therapy Advice

I understand that circle keepers do not give legal or financial advice, and they are not therapists. If I have questions about my legal rights, I can talk with a lawyer at any time.


Confidentiality

I understand that the Circles of Peace process is confidential under Oregon law (ORS 147.610). However, there are two exceptions:

1. If someone believes a serious crime may happen that could cause death or major injury.

2. If child or elder abuse or neglect is shared in front of a mandatory reporter, that person must report it.

I will be told if a mandatory reporter is present. I understand that information found outside the Circles of Peace process may still be used in court.


Privacy

I agree not to talk about what happens in Circles of Peace with anyone who was not there, unless both the harmed person and I agree in writing about what can be shared.


Private Meetings

I may have private talks with circle keepers or staff. These talks are also confidential unless I say otherwise.


Recording and Remote Meetings

I understand that recording any part of a restorative circle is not allowed. If we meet remotely through any means (for example, by Zoom or phone), I will make sure no one else listens or joins without permission from the other party and the circle keepers.


Sharing of Information

I understand that circle keepers and staff will not share information from Circles of Peace with anyone outside the program. I agree not to ask Six Rivers staff, volunteers, or contractors to testify or share confidential information in court or any other setting.


Program Evaluation and Research

For research and training, the Circles of Peace program may: Keep anonymous records and statistics about circle outcomes, record and publish statistical data that does not identify me, talk privately with staff and volunteers for learning purposes, and keep records as required by program policies.


Restraining Orders

I agree to tell Six Rivers if there are any restraining orders between people in the circle. If there is a restraining order, joint circles will not happen unless the order is temporarily lifted for Circles of Peace.


Weapons Policy

I understand that weapons of any kind (including, but not limited to, guns, knives, or explosives) are not allowed at any Six Rivers location or during Circles of Peace meetings.


Release of Liability

I agree to hold Six Rivers Dispute Resolution Center and any of its representatives, circle keepers, contractors, mediators, staff, Board members and volunteers harmless from any difficulties or damages connected to my participation or agreements made through Circles of Peace.


Program Research with the Oregon Criminal Justice Commission

I understand that Six Rivers will share my full name and date of birth with the Oregon Criminal Justice Commission only for research about program results. My information will stay confidential and be used only for research.


I agree to all of the above.


Today's Date: March 4, 2026

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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