Membership & Confidentiality Agreement Form

Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust

Membership is free.

By completing the Membership Form you agree to the following:

Members, Support parents, GRSNNZ, committee members & Associates will treat the families they support with dignity, honesty and will respect their values, feelings, beliefs and right to privacy. All information and communication will be held confidential within GRSNNZ and associated services. All information about the family is protected. Support parents do not discuss or disclose any information about the child or the family to anyone except to their GRSNNZ Coordinator or Manager, unless there has been written permission from parents prior. Members who are privilege to GRSNNZ management information and processes will respect the sensitive nature of this information and agree not to share confidential material with other organisations including all documents with copy right. You may at anytime access and correct your information. Privacy Act. 1994. Using provisions within the Privacy Act, any unlawful act can be reported to the appropriate authorities.

* indicates required
include area code
If option is not in above list
/ / ( dd / mm / yyyy )
…that we might be able to help you with – Details?
If any? No dosages please.
formula type/breastfed/special diets
Do you consent to Private Facebook Group(s)? * be invited?
GRSNNZ Newsletter Mailing List – PLEASE COMPLETE
We send quarterly newsletters.
Local Facebook Groups and/or News Mailing Lists
As per your consents.
Conditions Facebook Groups and/or Mailing Lists
As per your consents.
Postal – Can we post you a Welcome Pack? *
We like to Post you a Pack to acknowledge your journey.

The details provided are used to send newsletters and information as selected in your Mailing List choices. Other details are used for statistical and funding purposes. No identifiable information is released to third parties.

Click the following for the GROUP GUIDELINES You can unsubscribe at any time by clicking the link in the footer of our emails. For information about our privacy practices, please visit our website.

We use Mailchimp as our marketing platform. By clicking below to subscribe, you acknowledge that your information will be transferred to Mailchimp for processing. Learn more about Mailchimp’s privacy practices here.

Alternative versions of the form, if the one on this page doesn’t work for you:

MailChimp form

Scan the QR code at the bottom of the page.

Facebook form

You can also use these to update your details and list subscriptions, but please note that we are not notified of changes.  Please let us know if you want to be added to a Facebook Group or have an address change etc by forwarding these to us by email or using the contact form.

If you have any problems submitting a membership form please use the contact form to let us know.