Brain Hub Moderator Agreement
Please complete this form in order to be acquainted with the operations of the Global Online Patient Support Hub. Thank you for your willingness to help!
First and Last Name (Surname)
Primary Telephone Number (Please include country code, city code and telephone number):
Secondary Telephone Number (Please include, country code, city code and telephone number):
Home Address (Please include street number, street name, city, region and country):
Which position(s) are you interested in?
Hub Group Moderator
Hub Group Buddy (Help Encourage and Direct Conversation)
What is the name of the disease that is of interest to you as a moderator or buddy?
Please tell us about your connection to the relevant disorder of the group.
Please attest to the following statements.
I have NOT been diagnosed with any psychiatric that would hinder my ability to act as a moderator or buddy.
I have NOT been convicted of any felony (crime).
), please place a check in the box to affirm your agreement to the following policies.
You agree to abide by the privacy and confidentiality policies of the Hub.
You agree to abide by the policy to avoid obscenity, provocative or any defamatory language while using the Hub, including hate speech based on gender, race, national origin, religion or other similarly protected classifications.
You agree not to video record, audio record or take screenshots of any user of the Hub.
You agree not share your username or password with any other person, whether they are a Hub user or not.
You agree to actively monitor the group conversation, camera direction and camera usage of the group at all times while the group is in session.
You agree not to fundraise, market products, lobby for any idea, advocate for any political position or proselytize for any religious point of view.
You agree not to monopolize the conversation and encourage everyone in the group to participate in the discussion.
You agree to avoid bullying, harassment and any hostile behavior in the group, to keep an eye out for such behavior and to report such behavior in an email immediately to:
You agree not to facilitate the use of your camera or login information for any person under 18 years of age.
You agree not invite, facilitate, offer the use of your camera or login information for any person that has not formally consented to being a Hub group member.
You agree to alert us of any behavior by any user, whether on video or text, that violates or gives the appearance of violating Hub policies.
You agree not to provide a diagnosis, suggest any drugs to use, recommend treatment or otherwise provide what may appear to be medical advice.
You agree not to hold Defeat MSA, the Global Online Support Hub or individuals associated with those entities liable for your behavior or the behavior of other users of the Hub.
You affirm that you have read the above statements carefully and that you have personally agreed with each of these policies. Please electronically sign below. Thank you!
A copy of your responses will be emailed to the address you provided.
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service