GRSNNZ Membership & Confidentiality Agreement Form

Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form

By completing the Membership Form you agree to the following:

A CONFIDENTIALITY agreement with all parents/members/coffee/support group conveners/committee, staff and support agencies is needed. Please find below our agreement of Confidentiality for you to read and agree to. This agreement will protect all parties when sharing personal details with GRSNNZ and associated services. For those of you who have shown interest in attending a local support group meeting, becoming support parents or committee members this agreement is necessary for participation.

AGREEMENT: 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, Crying Over Spilt Milk, Coordinator or Manager, unless there has been written permission from parents prior. Members who are privilege to GRSNNZ or COSM 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.

NB: The question about consent for Private Facebook Groups relate to the groups used to organise your local and other support group(s) meetings and contacts.

*At the end of the form are options for you to subscribe to various mailing lists.

* indicates required

Do you consent to Private Facebook Group(s)? *


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

An alternative form is also available here: