GRSNNZ Membership and Mailing Lists Subscription

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
If joining for child
include area code
If option is not in above list
(You will be given the option to add additional family members when this form has been submitted)
choose primary diagnosis
...that we might be able to help you with - Details?
If any? No dosages please
breastfed/formula type/special diets
To be invited?

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.

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