Blood Brother Enrollment

Participation

I agree to participate in the HFA Blood Brotherhood Program. As a participant, I understand and agree to attend all HFA Blood Brotherhood activities, to the best of my ability.

I understand and agree that I will be required to complete a pre- and post- participation survey which may include personal data and information. I understand and agree that information provided in these surveys may be utilized by HFA, in a non-identifiable and confidential manner, in order to provide documentation and data for grant funding and program evaluation purposes.

I understand the need for and I agree to protect the confidentiality of any and all personal information shared by all participants during HFA Blood Brotherhood Activities in which I am involved.

I also understand the importance of all participants feeling comfortable in sharing personal information within a HFA Blood Brotherhood Group.

I agree to maintain the confidentiality of any and all personal information shared by participants.

Photo Release

I authorize the use of photographs or videos for HFA use only.

Confidentiality

I understand that HFA wishes to insure the comfort level of participants in sharing information so they can structure the presentations to include their personal information if desired. I understand that Confidentiality is required to be maintained and will be observed in all HFA Blood Brotherhood Activities.

HFA Blood Brotherhood Activities

I understand and agree that I will not discuss personal information about my peers learned during any HFA Blood Brotherhood activities. I also agree that I may not discuss any personal information learned with any individual, entity or representatives of any Pharmaceutical Company, HTC, Homecare Provider, Pharmacy or other Healthcare Provider.