Online Support Group Consent Form
 
If you are happy to take part in the Bone Cancer Research Trust online support group, please read the declaration below, complete and submit this form.

No young person will be allowed to take part in the group without agreeing to the declaration and providing full emergency contact details.
 
1. I consent to taking part in The Bone Cancer Research Trust online support group.

2. I consent to the information I have provided within this form being held on a database for the purpose of administration in relation to the organisation of the online support groups.  In addition, I agree that this information can be utilised to ensure quick access to emergency contact details when necessary to do so whilst running the online support group.

3. I acknowledge that at least 2 staff members will be involved in an online support group, whether 1:1 or groups with multiple participants.

4. I understand that any inappropriate behaviour towards staff and other patients and carers (friends, siblings etc) will see me barred from all Bone Cancer Research Trust activities and events and removed from the group.  Inappropriate behaviour includes: Language or actions that are deemed to be abusive, offensive, discriminatory, obscene, vulgar, sexually orientated, hateful, threatening or violate any laws.

5. I understand that whilst the Bone Cancer Research Trust Staff are in charge they will take all reasonable care of the young people in their care and unless they are negligent they cannot be held responsible for any loss, damage or injury suffered by any young person arising during the online support groups..

6. I understand that the online support groups cannot be used to ask medical or clinical questions or opinions.  

7. I agree to sharing my next of kin details as part of consent process before I can join an online support group.

8. I understand that this form is subject to a 12-month review and it is my responsibility to inform the Support and Information Team if any of the details provided in this form change.

Name
Date of Birth *
Email *
Address *
Phone number *
I would prefer to be contacted via:
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By completing and submitting this form you agree to the terms and conditions stated above:
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Next of Kin Name
Relationship
Phone Number
Second Next of Kin Name
Relationship
Phone Number
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