CF Youth/Teen Group Consent
Moderated Video Chat
What is your timezone?
What are some times that your child would be available to connect with their peers?
CF Care Center
Clinic Social Worker
Name and Number
Can we inform your clinic that your child is involved in our program?
Does your child live with:
In a couple of sentences-what is your child's perspective on living with CF?
Please tell us a little about your child and their hobbies, so we can best match them with others who have similar interests.
Would you like to set up a phone call to answer any questions?
We are really looking forward to creating a community, enhancing peer support and reducing the feelings of isolation associated with CF. Thank you for your interest.
Waiver for Participation:
I hereby release and hold harmless representatives of Attain Health, the Rock CF Foundation, and any associated sponsors. By signing this, I agree that my child is engaging in this program of their own will. I understand that they are going to talk with other individuals living with CF and that their diagnosis will be made clear by engaging in this program.
My signature is my consent for my child to engage in a moderated support group. I agree:
Should be Empty: