By registering for our support group, I acknowledge that I may participate at any level I feel comfortable with.  I understand that the support group will include discussions of healthcare, personal experiences, work and family issues, and the management of chronic pain.  I further understand that the support group leaders are volunteers and that they are not physicians, psychiatrists, psychologists, or other trained healthcare professionals. Our support group is provided for educational and support purposes - it is not a therapy group. Our support group is dedicated to serving those who live with pain conditions, but does not advocate any one particular treatment for any one type of pain.

I acknowledge that the support group leaders, by making this support group available, are not undertaking any responsibility regarding my medical condition. If my medical condition is adversely affected by my participation in the support group, I understand that it is my responsibility to discontinue participation.

I agree that all information obtained in the support group is to be considered confidential, and I shall hold the same in confidence, shall not disclose, publish, or otherwise reveal any of the confidential information received from any participants in the support to any other party whatsoever. I agree not to make any recording (audio and/or video) of the support group.

I agree to hold harmless the support group leader and members from any claims for personal injuries, expenses, and any other loss arising from my participation in the support group.

I have read this waiver and confirm that I have been allowed to ask any questions, and I fully understand and agree to the above.