Neuroblastoma Australia Family Support Group Registration Form

We know that having your child diagnosed with neuroblastoma is earth shattering. Suddenly you are catapulted into a world you never knew existed, forced to support your child through harsh treatments and attempt to balance the rest of your life. At times it feels very isolating, with friends and family unable to comprehend what you’re going through or how to best provide support. This group is a chance to connect with other parents of children diagnosed with neuroblastoma. It is an opportunity to talk about your child, the impact of treatment protocol, share tips and importantly connect with others who understand.

Neuroblastoma Australia has engaged an experienced support group facilitator to facilitate this virtual group. It will be a safe space for you to talk openly about your child, share the ups and the downs and ask questions of other parents. If you would rather just listen, that’s okay too! The aim of the group is to connect you with other families dealing with neuroblastoma so you can build a supportive network on your child’s journey.

If you would prefer not to use your camera, you can still join in with just audio.
Your device will need to have an in-built microphone and speakers, or you will need a headset.

This group is for you if:
- You are a parent of a child 0-18 years old who has been diagnosed with neuroblastoma (any stage)
- You want to meet and talk with other parents who also have a child on treatment for neuroblastoma

Details:

Date: 2nd Thursday of Every Month (subject to change depending on demand)
Time: Evenings (after 6.30 pm AEDT) - QLD, NSW, VIC, ACT & TAS
Where: Online (via ZOOM)
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Time by State:

NT & SA (ACST) | TBC but after 4 pm

WA (AWST) | TBC but after 2.30 pm

(Please take note of your relevant timezone)
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After you register, one of the facilitators will give you a call to check-in, confirm the date/time for the group call, and answer any questions you may have. They will also send a reminder email with a link to join the group.

If you have any questions, please feel welcome to contact us at [email protected]

For further information and latest updates visit our website www.neuroblastoma.org.au

First Name (required)

Last Name (required)

Preferred contact phone number (required)

Your Email (required)

Street Address (required)

Suburb (required)

State (required)

Postcode (required)

Do you have a partner that will be attending the group with you (required)

Partner details (if attending)

First Name (required)

Last Name (required)

Phone number (required)

Preferred method of contact (required)

EmailPhone

Your Child’s details

Child’s first Name (required)

Child’s last Name (required)

Date of birth (required)

Your child’s date of diagnosis (required)

Your child’s diagnosis and stage (we are requesting this information to try and have parents who have children with similar diagnosis in the same group) (required)

Will you be joining the call via mobile phone or computer (desktop or laptop?) (required)

Other information

Please advise what your preferred time of session would be? (required)

Please advise if there are any days of the week you can not do? (required)

It is helpful for us to know what made you interested in this group? Also can you tell us what you would like to get out of this group?

How did you hear about this group?

Other (if selected)

The information I have provided information is correct, and I agree to this being shared with Neuroblastoma Australia (required)

Yes

Confidentiality

Information shared by parents in the group will be kept confidential. All participants will be asked to respect this. The facilitator will maintain participants’ confidentiality unless there is a duty of care or legal requirement (e.g. if there is a significant risk to someone’s safety) that requires them to notify another relevant party

• We may also use your details to inform you of other Neuroblastoma Australia services that we think may be relevant to you, and to invite you to family events.

• From time to time, we may also contact you for research and evaluation purposes and/or the opportunity to contribute to Neuroblastoma Australia and its services. You’ll of course have the opportunity to participate or not as these opportunities arise.

• If you would prefer not to receive updates or invitations, let us know at any time by contacting [email protected] Details of the Neuroblastoma Australia Privacy Policy can be found on our website https://www.neuroblastoma.org.au/.

• Neuroblastoma Australia and the group facilitator may contact individual participants or the entire group via phone & email regarding participating in the group.

• Participants are more than welcome to have contact with each other outside the group, however, please know Neuroblastoma Australia and the facilitators cannot share contact information without consent.

I agree with the above confidentiality statement (required)

Yes

Send