Kids Programming Parental Consent Form

Due to the nature of this program and the ages of the participants involved, additional consent waivers are needed to participant in this program. Zoom information will not be sent until a staff member has reviewed & confirmed participant eligibility and parent/guardian consent.

My Child plans to attend:

7/8 12pm ET - Art Class for Kids7/10 1:30pm ET - Magic Show with Mario the Maker Magician

Parent/Guardian Information

First Name

Last Name

Zoom information will be sent to this email AND program participant's email, if applicable

Cell Phone Number

Program Participant's Information

First Name

Last Name

Validation 2

Birthdate

Please provide a birthdate to confirm the program participant meets the age requirements for this program.

Condition connection:

I am/They are affected by:

Diagnosis is:

To register another participant, select "add another response" ↓

Waiver/Consent Form

Acknowledgements and Agreements

I hereby consent to have my child participate in an online virtual social group event to be provided by The Marfan Foundation. I acknowledge and understand the following:

1. That the purpose of this virtual social group program (the “Program”) is to offer social connections for individuals under 13 years of age who have a diagnosis of Marfan syndrome, VEDS, Loeys-Dietz syndrome, or a related genetic aortic or vascular condition (collectively, “Group Members”);

2. That this Program is being provided via Zoom video conferencing. Although the Marfan Foundation has group guidelines in place to create a safe and supportive virtual environment, due to the nature of this technology, we cannot guarantee privacy for the Group Members that participant in the Program. It is important that your child be in a private area where your child will not be interrupted while participating in the Program;

3. That the following ground rules are important to create a safe and supportive environment for all Group Members: A) show respect to others, B) allow others time to participate, and C) freedom to choose whether to participate;

4. That family members or friends who are not Group Members may not participate in the Program;

5. That any Group Member may be removed from the group if they do not follow the guidelines and ground rules listed above;

6. That the sessions may be photographed or recorded by the Marfan Foundation for the purpose of archival or promotional purposes. In this regard, I give my consent for my child's participation in the Program to be included in any promotional activities by the Marfan Foundation; and

7. That by signing this consent form I hereby give my permission for my child to participate in the Program as a Group Member.

Consent to Participation

By signing below and having my child participate in the Program as a Group Member, I acknowledge and agree to the terms and conditions set forth above. I understand that my child's personal information shall be stored in a database or secure databank and sharing of this information shall be limited to the Marfan Foundation's staff, employees, or management. I hereby give my consent for my child's participation as a Group Member in the Program to be conducted and organized by The Marfan Foundation.

ACCEPTED AND AGREED:

Parent/Guardian Electronic Signature

Date