NSF Peer Connections Program Interest Form (designed for young patients, age 13 & Under)

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NSF's CONNECTIONS Program is an opportunity for young Nephrotic Syndrome warriors, 13 years and younger, who have a desire to support others navigating Nephrotic Syndrome, and who would like to be part of a community for support as well. Siblings 13 years and younger, are also welcome!

The NSF Peer Connections Program will be guided by The NSF Peer Team, a group of young adults and older teens who themselves walk the journey of life with Nephrotic Syndrome. The NSF Peer Team is here to support others battling Nephrotic Syndrome and are passionate about encouraging younger community members to get involved through the Peer Connections Program. The NSF Peer Team is here to speak with parents, share experiences with young warriors and simply be a part of a collaborative and supportive community.

There are many ways to get involved and we look forward to learning about your goals for involvement with the team!

Please reach out to nsfpeerteam@nephroticsyndromefoundation.org with any questions you may have or interest in volunteering beyond the Peer Connections Program for young warriors age 13 and under.

Required Acknowledgement: *

I understand that NSF Peer Team Connections are available for minors 13 years and younger with parent/guardian consent.

Required

Parent/Guardian's Name *

Parent/Guardian Email *

Are you interested in receiving future emails from the Nephrotic Syndrome Foundation about upcoming Peer Connection Events? *

Yes

Parent/Guardian's Phone Number *

Required Acknowledgement:

I understand that minors, ages 13 and under, will be contacted via their parent/guardian's contact information provided above

Required Acknowledgment: *

I am the legal guardian / parent of a minor ages 13 and under, and I hereby give my permission for them to participate with NSF Peer Connections independently, such as through social media and with Peer Connection programming, under my care and supervision.

I am the legal guardian / parent of a minor ages 13 and under, and I hereby do not give my permission for them to participate with NSF Peer Connections independently, such as through social media and with Peer Connection programming, under my care and supervision.

Required

Minor Participant's Name *

Minor Participant's Identified Gender

Minor Participant's Preferred Pronouns

Minor Participants's Age (13 & under) *

Minor Participant's relationship to Nephrotic Syndrome (i.e. patient, sibling of patient) *

What are the participant's interests & strengths? Is anything in particular they are passionate about contributing to the NSF Peer Connection effort?

Is there anything else we should know about the participant? i.e do they live outside the United States?

Required Acknowledgement: *

I hereby acknowledge I am responsible for the safety and wellbeing of myself / my child while participating in these (or other) activities facilitated by NSF. I acknowledge that NSF offers age requirements for sessions and agree to hereby adhere to all such requirements. I also understand these are guidelines only, and take full and final responsibility for my own / my child’s wellbeing and participation in these events regardless of age.

Required

Required Acknowledgement: *

I agree to hold harmless NSF, Peer Team Leads, and any other related parties who may communicate with me / my child as part of these programs or thereafter. I understand I am fully responsible for monitoring the appropriateness of the subject matter and / or communications within these sessions or otherwise.

Required

Required Acknowledgement: *

I acknowledge and understand that NSF does not in any way provide medical advice, guidance or suggested protocols for managing or treating Nephrotic Syndrome. Materials, information and / or content presented in these sessions are offered for informational purposes only. The opinions expressed in our sessions are those of the participants only and do not in any way constitute medical advice or guidance. Always seek the advice of your physician or other qualified health provider with any questions you may have or before making any change in your treatment, diet or health protocol.

Required

Required Acknowledgement: *

The Nephrotic Syndrome Foundation reserves the right to refuse or dismiss anyone that may cause any disturbance or hindrance in any manner that could jeopardize the safety or wellbeing of oneself or others.

Required

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