Survey | RESOLVE

Alabama Virtual Peer-led Support Group Notification Form

Please complete this form and RESOLVE staff will contact you when the support group has been launched. Your responses will be confidential, and RESOLVE does NOT share this information with any outside organizations or persons. What you choose to share with your group is up to you. RESOLVE's Privacy Policy

First Name

Last Name

City

State

ZIP Postal Code

Mobile Phone

Email Address

What is your relationship to infertility?

Communications

Yes, I want to receive email communications from RESOLVE.

What are you hoping to get out of the support group?

RESOLVE does not allow professionals, researchers, students, etc. to participate as an observer in these meetings for any reason. Contact [email protected] to submit a research study or other request. By selecting "I understand" option below, you confirm that you understand and agree to these terms.

I Understand

To ensure that PLSGs, both in-person and virtual, are emotionally safe, supportive, productive, and the best experience possible for group members, it is important for each member to make a commitment to abide by RESOLVE’s guidelines for participation.

RESOLVE Assumption of Risk and Liability Release Waiver

PLEASE READ CAREFULLY. THIS AGREEMENT INCLUDES A WAIVER OF LIABILITY AND DEPRIVES YOU OF THE RIGHT TO SUE RESOLVE AND OTHER WAIVED PARTIES.

RESOLVE: The National Infertility Association is pleased to be able to resume in-person programs in accordance with state and local regulations. In consideration of the opportunity to participate in Peer-Led Support Groups (the “Program”), I acknowledge and agree to the following:

Liability Waiver

By attending the Program, I hereby release and waive, on behalf of myself and anyone else who might claim on my behalf, RESOLVE, Inc. (including its board members, officers, agents, servants, independent contractors, affiliates, employees, successors, volunteers, and assigns, collectively, “RESOLVE”) from all responsibility, claims, liability, demands, and financial obligation relating to my participation during, before, and following the Program, or any related RESOLVE sanctioned or unsanctioned events, transportation, or activities.
I understand that while every attempt will be made to ensure the safety and security of all participants and attendees at RESOLVE events and meetings, RESOLVE is not responsible for any property damage, injury, accidents, illness, or death, including those related to COVID-19, which may occur before, during and following any such events, including those that may arise from the negligence of RESOLVE.

RESOLVE Peer-Led Support Groups are not Treatment Services

I understand that RESOLVE peer-led support groups are not, and are not intended to be, medical, psychological, or other professional health care treatment services or therapy services, and no client/therapist relationship is formed by my participation. Participation in the RESOLVE peer-led support groups is not a replacement for private counseling or a professionally-led support group.

I have read and agree to the above Peer-Led Support Group Guidelines and Waiver

I Agree

Thank you sponsor

RESOLVE is a non-profit, 501(c)(3) organization certified under the National Health Council Standards of Excellence and America's Best Charities as well as earned the Guidestar Gold Seal of Transparency.

RESOLVE: The National Infertility Association
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