Peer Support Specialist Disclosure Form

Gabriel Fernandez | Independent Peer Support Specialist

The Purpose Factory, LLC

Phone: 719-601-6030 | Email: The.purpose.factory.llc@gmail.com

Introduction

My name is Gabriel Fernandez. I am a State Certified Peer and Family Specialist through the Colorado Providers Association (COPA), meeting all state certification requirements. I provide peer support services independently through The Purpose Factory, LLC.

As a Peer Support Specialist, I use my lived experience and professional training to offer mentorship, emotional support, and practical guidance to individuals navigating personal challenges, recovery, and life transitions. My role is to support you in finding your own strengths, building life and job skills, and pursuing a meaningful and purpose-driven life.

Scope of Services

- Providing mentorship, emotional encouragement, and advocacy.
- Teaching and supporting life and job skills development.
- Assisting with goal setting, wellness planning, and problem solving.
- Sharing resources, tools, and coping strategies based on lived experience.
- Supporting the pursuit of personal growth, purpose, and employment readiness.

**Please Note:**
- I am not a licensed counselor, therapist, or medical professional.
- I do not provide clinical mental health treatment, medical advice, or crisis intervention.
- Peer support services are based on mutual respect, shared experience, and voluntary participation.

Confidentiality

Your privacy is important to me. Information shared during our sessions will be kept confidential, with the following exceptions where I am legally required to report:
- Threats of harm to yourself or others.
- Suspected abuse or neglect of a child, elder, or vulnerable adult.
- If subpoenaed by a court of law.

Outside of these circumstances, information will only be shared with your written consent.

Professional Relationship

Our relationship is professional and peer-based. Personal, romantic, or financial relationships outside of peer support services are strictly prohibited.

Voluntary Participation

Engagement in peer support services is completely voluntary. You may end services at any time without penalty.

Contact Information

For scheduling, questions, or concerns, you may contact me at:
Phone: 719-601-6030
Email: The.purpose.factory.llc@gmail.com

Acknowledgment

By signing below, you acknowledge that you have read, understand, and agree to the terms outlined in this disclosure form.

Client Name: _________________________________________
Client Signature: _____________________________________
Date: _____________________

Peer Support Specialist Signature: _______________________________________
Date: ________________________

The Purpose Factory

Release of Liability, Transportation, and Mentoring Agreement

Participant Name:

Date of Birth:

Parent/Guardian Name (if under 18):

1. Consent to Participate

I, the undersigned, consent to allow the above-named participant to engage in activities organized by The Purpose Factory, including mentoring, skills training, hands-on work experience, and transportation between worksites.

2. Transportation Agreement

I acknowledge and agree that staff, volunteers, and mentors associated with The Purpose Factory may transport the participant in their personal or company vehicles between job sites, training locations, or other related activity venues.

I release The Purpose Factory and its staff, volunteers, and affiliates from any liability arising from transportation-related incidents, except in cases of gross negligence or intentional misconduct.

3. Worksite and Mentoring Activities

I understand that the participant will engage in real-world job training and work experience activities that may involve physical activity, use of tools or equipment, or exposure to typical workplace hazards.

I consent to their participation and acknowledge the inherent risks involved.

 

4. Release of Liability

In consideration for the opportunity to participate, I hereby release and hold harmless The Purpose Factory, its directors, employees, volunteers, mentors, and agents from any and all claims, demands, actions, or causes of action arising out of or relating to any injury, accident, illness, or damage that may occur during or as a result of participation in any activities organized by The Purpose Factory.

 

5. Medical Consent

In case of emergency, I authorize The Purpose Factory representatives to obtain necessary medical treatment for the participant. I understand that I am responsible for any medical expenses incurred.

 

6. Media Release (Optional)

[  ] I give permission for photographs, videos, and recordings of the participant to be used for promotional purposes by The Purpose Factory.

[  ] I do not give permission.

 

Signatures

Participant Signature (if 18 or older): __________________________

Date: __________________________

Parent/Guardian Signature (if participant is under 18): __________________________

Date: _________________________

Purpose Factory Representative: __________________________

Date: __________________________

Emergency Contact:

Name:_____________________________________

Number:_____________________________________

The Purpose Program Permission Form

Youth Participation Permission Slip

Program: The Purpose Program

Organization: The Purpose Factory

Location: Pueblo and El Paso Counties, Colorado

Participant Age Range: 12–18 years old

Participant Information:

• Full Name of Youth: __________________________
  
  
• Date of Birth: __________________________
  
  
• Address: __________________________
  
  
• Emergency Contact Name & Relationship: __________________________
  
  
• Emergency Contact Phone Number: __________________________
  

Purpose of the Program:

The Purpose Program provides adolescents with opportunities for community socialization, mentorship, life skills development, and hands-on work experience under the supervision of The Purpose Factory staff and volunteers.

Activities may include but are not limited to:

• Community service projects
  
  
• Local outings and social activities
  
  
• Hands-on work experiences in fields such as landscaping, auto detailing, meal preparation, and general labor
  
  
• Workshops on wellness, goal-setting, and job skills
  
  

Guardian Permission and Acknowledgement:

By signing below, I hereby:

• Give permission for my child to participate in all Purpose Program activities, including community social outings and work experiences.
  
  
• Understand that activities may occur at various approved community locations.
  
  
• Acknowledge that The Purpose Factory staff will supervise all activities and ensure a safe environment.
  
  
• Agree to promptly notify The Purpose Factory of any medical conditions, allergies, or concerns that may affect my child’s participation.
  
  
• Release The Purpose Factory, its staff, volunteers, and affiliates from any liability for injuries or incidents that occur during program participation, except in cases of gross negligence or intentional misconduct.
  

Medical Authorization:

In case of emergency, I authorize The Purpose Factory staff to seek emergency medical treatment for my child. I understand that I will be contacted as soon as possible.

• Known Allergies/Medical Conditions: ____________________________________________
  
  
• Medications (if any): ____________________________________________
  

 

Guardian Information and Signature:

• Full Name of Guardian: __________________________
  
  
• Relationship to Youth: __________________________
  
  
• Phone Number: __________________________
  
  
• Email Address (optional): __________________________
  
  

Signature of Guardian: __________________________

Date: __________________________

The Purpose Factory Contact Information:

Website: www.thepurposefactory.org

Phone: 719-601-6030

Email: the.purpose.factory.llc@gmail.com

The Purpose Factory – Safe Environment Policy

Effective Date: 04-20-2025

Purpose: The Purpose Factory is committed to maintaining a safe, supportive, and professional environment for all youth participants, mentors, and staff.

Policy Statement: To protect the safety and well-being of all participants:

• Private one-on-one meetings between staff/mentors and youth are not permitted.
  
  
• All activities and mentoring interactions must occur in group settings or public work environments such as:
  
  
• Job sites
  
  
• Group workshops
  
  
• Scheduled events
  
  
• Any exception (such as necessary transportation or work-related supervision) must occur in a public setting (e.g., transportation with multiple youth, visible areas, or other adults nearby).
  
  

Expectations:

• Mentors must always ensure visibility and accountability when interacting with youth.
  
  
• Youth will be supervised during all program hours.
  
  
• Parents/Guardians are encouraged to communicate openly with program staff about any concerns.
  
  

Commitment:

This policy is designed to create an atmosphere of trust, professionalism, and safety for everyone involved with The Purpose Program.

Acknowledgement:

All staff, volunteers, and participants must agree to abide by this policy as a condition of involvement with The Purpose Program.

The Purpose Factory – Safety Policy

At The Purpose Factory, creating a safe, supportive, and empowering environment is our top priority.

To maintain a space where all participants can grow and thrive, the following policies are strictly enforced:

1. Substance-Free Environment

• We respect and support individuals who are overcoming addiction.
  
• However, there is a zero tolerance policy for the use of alcohol, drugs, or any substances during program engagement.
  
• Participants must show up sober to all events, activities, and work sessions.
  
• If a participant is struggling to meet this expectation, The Purpose Factory will offer help by connecting them to appropriate resources and support services.
  
• Being under the influence while participating will result in removal from activities for safety reasons.
  

2. No Bullying Policy

• Bullying of any kind — physical, verbal, emotional, or cyber — will not be tolerated.
  
• All participants are expected to treat one another with respect and kindness.
  

3. No Violence Policy

• Any act of violence or aggressive behavior toward others will result in immediate removal from the program environment.
  
• We are committed to maintaining a peaceful and positive community.
  

4. No Weapons Policy

• No weapons of any kind (including firearms, knives, or any other dangerous objects) are allowed at any Purpose Factory events, job sites, or program locations.
  
• Possession of a weapon will result in immediate disciplinary action, up to and including termination of program involvement.

5. No Gang Activity or Gang Affiliation

• Gang activity, symbolism, promotion, or idealization of gang culture is strictly prohibited.
  
• Clothing, hand signs, graffiti, or behavior associated with gang involvement are not allowed at any Purpose Factory function.
  
• We aim to create a space where all youth feel safe, free of intimidation, and empowered to build positive futures.

6. Appropriate Use of Work Equipment

• All tools, machinery, and work equipment must be used responsibly and appropriately at all times.
  
• Equipment is to be used only for its intended purpose and only after proper instruction or supervision has been provided.
  
• Reckless, unsafe, or intentional misuse of work equipment will result in immediate corrective action and may lead to removal from activities or the program.
  
• Safety gear must be worn when required, and all participants must follow established safety procedures.
  

Commitment to a Safe Space

By participating in The Purpose Factory programs, all individuals agree to uphold these standards and contribute to a healthy, safe, and welcoming environment for everyone.

 

Support The Purpose Program

Your donation directly empowers local youth ages 12–18 in Pueblo County with hands-on work experience, mentorship, life skills training direct support in helping remove barriers to finding passion within their purpose.

Research shows that youth in programs like ours are 30% more likely to pursue higher education and community leadership.

Every dollar you give helps fund workshops, community service projects, and one day, safe spaces where young people can discover their passions and build a purposeful future.

100% of your donation goes directly to into supporting youth development.

Together, we’re shaping stronger individuals and a stronger community.

Thank you for investing in the future of our community!

https://gofund.me/794735d5

Welcome to The Purpose Factory - Where potential meets purpose. by k5my2mp8hh

Frequently Asked Questions (FAQ) | The Purpose Factory

 

1. What is The Purpose Factory?

The Purpose Factory is a social enterprise in Pueblo, Colorado that provides free peer support services, life skills mentoring, and hands-on job training for youth ages 12–18.

Our mission is to help young people discover their passions and build a future filled with purpose.

2. What is The Purpose Program?

The Purpose Program is our flagship initiative that offers free access to life skills education, volunteer work experience, mentorship, and financial support to local adolescents.

Each participant can earn up to $500 per year to support their passions and career goals through consistent participation. Funds are used to help remove the barriers to their goals. While they earn access to this monetary support, the money is never directly given to participants of The Purpose Program as it is managed by staff and each purpose support transaction is approved by the owner before purchase.

3. Is The Purpose Program really free?

Yes!

The Purpose Program is 100% free for all youth participants.

We never bill insurance or charge families for participation.

Our operations are funded through service revenue (such as auto detailing, junk removal, landscaping, meal prep) and community donations.

100% of Donations to the Purpose Program goes straight into the program itself providing support to the participants directly.

4. Who can join The Purpose Program?

The program is open to youth between the ages of 12 and 18 who live in Pueblo County, Colorado.

We welcome all participants, regardless of background, income, or academic standing.

Interest form,  Permission slip and Liability form must be signed by legal guardian before participating in our program.

5. How does The Purpose Factory fund its programs?

We fund our youth mentorship and skill-building programs through:

• Service-based businesses: Mobile auto wash and detailing, power washing, landscaping, junk removal, and meal preparation services
• Donations: 100% of public donations go directly to The Purpose Program
• Merchandise Sales: A portion of sales supports youth programming

6. Where is The Purpose Factory located?

Currently, The Purpose Factory operates through a flexible event calendar across Pueblo County.

We do not yet have a permanent physical location but plan to open a youth safe space in Pueblo County soon.

Follow our Event Calendar to stay updated on volunteer opportunities and workshops!

7. What services does The Purpose Factory offer to the public?

We offer high-quality, affordable services including:

• Mobile auto wash and detailing
• Residential and commercial power washing
• Landscaping services
• Junk removal services (coming soon)
• Meal preparation services ($9 per meal coming soon)

By using our services, you help fund free youth programs in your community!

8. How does volunteering work?

Participants of the Purpose Program are able to volunteer in supervised work environments to gain real-world life and job skills. They are open to participate in jobs as the schedule fits with jobs and their schedule (respecting school hours and done before 7PM).

Volunteering hours also help them earn access to earn up to a maximum of a $500 annual purpose fund.

this fun is used to help remove barriers to pursuing their purpose. This may be by paying for athletic fees or other equipment/fees related to the purpose they are pursuing.

Please note: Volunteering is not employment — it is a learning opportunity for youth development.

9. How can I support The Purpose Factory?

You can support our mission by:

• Booking our services
• Making a donation
• Purchasing merchandise
• Spreading the word on social media
• Volunteering to mentor or help with events

Visit www.thepurposefactory.org to get involved!

10. How do I enroll my child in The Purpose Program?

Enrollment is easy!

Parents or guardians can fill out an application here and sign a permission slip to get started.

The Purpose Program Application

Space is limited, so sign up today to reserve your spot!

Ready to Discover Purpose?

If you have any other questions, feel free to Contact Us — we’re here!

 

Youth mentoring Pueblo

Life skills training Colorado

Free adolescent programs Colorado

Job skills for teens Pueblo and El Paso County

Peer support for youth Colorado