Confidential New Peer-Led Support Group Member Sign Up

Please complete this form before joining your first support group. Once you have submitted the form, please forward the submission confirmation email to the Peer Host of the applicable support group you wish to join. Your responses will be confidential, and RESOLVE does NOT share this information with any outside organizations or persons. What you choose to share with your group is up to you.
1. Please fill out the following:
Date of Birth:
Demographic Information: Demographic information is used for RESOLVE internal reporting to ensure our programs reach all people in the family building community. RESOLVE's Privacy Policy
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6. (Maximum response 255 chars, approx. 5 rows of text)
7. Field Is Required RESOLVE does not allow professionals, researchers, students, etc. to participate as an observer in these meetings for any reason. Contact info@resolve.org to submit a research study or other request. By selecting "I understand" option below, you confirm that you understand and agree to these terms.
To ensure that PLSGs, both in-person and virtual, are emotionally safe, supportive, productive, and the best experience possible for group members, it is important for each member to make a commitment to abide by RESOLVE’s guidelines for participation.
8. Field Is Required By selecting "I understand" option below, you confirm that you understand and agree to RESOLVE's guidelines for participation.

RESOLVE Assumption of Risk and Liability Release Waiver

PLEASE READ CAREFULLY. THIS AGREEMENT INCLUDES A WAIVER OF LIABILITY AND DEPRIVES YOU OF THE RIGHT TO SUE RESOLVE AND OTHER WAIVED PARTIES.

RESOLVE: The National Infertility Association is pleased to be able to resume in-person programs in accordance with state and local regulations. In consideration of the opportunity to participate in Peer-Led Support Groups (the “Program”), I acknowledge and agree to the following:

Liability Waiver

  • By attending the Program, I hereby release and waive, on behalf of myself and anyone else who might claim on my behalf, RESOLVE, Inc. (including its board members, officers, agents, servants, independent contractors, affiliates, employees, successors, volunteers, and assigns, collectively, “RESOLVE”) from all responsibility, claims, liability, demands, and financial obligation relating to my participation during, before, and following the Program, or any related RESOLVE sanctioned or unsanctioned events, transportation, or activities.
  • I understand that while every attempt will be made to ensure the safety and security of all participants and attendees at RESOLVE events and meetings, RESOLVE is not responsible for any property damage, injury, accidents, illness, or death, including those related to COVID-19, which may occur before, during and following any such events, including those that may arise from the negligence of RESOLVE.

RESOLVE Peer-Led Support Groups are not Treatment Services

  • I understand that RESOLVE peer-led support groups are not, and are not intended to be, medical, psychological, or other professional health care treatment services or therapy services, and no client/therapist relationship is formed by my participation. Participation in the RESOLVE peer-led support groups is not a replacement for private counseling or a professionally-led support group.

COVID-19 Safety Warning and Acknowledgement

  • COVID-19 and COVID-19 variants carry inherent risks: I am fully aware that participation in the Program, including any related travel, carries with it certain inherent risks related to COVID-19 transmission, exposure and/or infection, the exact nature of which are not currently ascertainable, and which may not be eliminated or reduced regardless of the care taken to avoid such risks. These risks may include but are not limited to, (1) the risk of coming into close contact with, or otherwise being exposed to, individuals or objects that may be carrying COVID-19; (2) the risk of transmitting or contracting COVID-19, directly or indirectly, to or from other individuals; and (3) injuries and complications ranging in severity from minor to catastrophic, including injury, illness, disability and death, resulting directly or indirectly from COVID-19 or the treatment thereof.
  • I am responsible for risks associated with COVID-19: I understand I am fully and personally responsible for my own safety and actions during my participation in the Program. I understand and voluntarily assume the risk of becoming exposed to or infected by COVID-19 during RESOLVE activities, which may result from the actions, omissions, or negligence of myself and others, including, but not limited to, RESOLVE volunteers, leaders, and staff.
  • I will not participate in RESOLVE’s in-person events if I may have COVID-19:I understand that the following are symptoms of COVID-19: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea (“COVID-19 Symptoms”).  I certify that in the last 14 days, I have not experienced COVID-19 Symptoms or been in close contact with anyone with COVID-19 Symptoms or who has tested positive for the COVID-19 Virus. If I develop any COVID-19 Symptoms, test positive for COVID-19, or am in close contact with someone with COVID-19 Symptoms or who has tested positive for COVID-19 prior to beginning RESOLVE affiliated activities, I will not participate in RESOLVE activities or gatherings.
  • I acknowledge that I have read RESOLVE’s COVID-19 Procedures and agree to adhere to them.

By signing below I acknowledge that (1) I am at least eighteen years old and fully competent to give my consent, (2) I have read and understood this Liability Release Waiver, (3) I have been sufficiently informed of the risks involved in connection with the Program, (4) I am signing this Liability Release Waiver freely and voluntarily in order to participate in the Program, and (5) I am giving up legal rights and/or remedies which may be available to me.

COVID Procedures for RESOLVE Programs

COVID-19 Warning

The World Health Organization has declared the novel coronavirus, COVID-19, as a worldwide pandemic. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, and in accordance with federal, state, and local regulations, RESOLVE has put in place various preventative measures to reduce the spread of COVID-19. Despite these measures and the best intentions of RESOLVE, RESOLVE cannot guarantee that you will not become infected with COVID-19 as a result of participating in RESOLVE’s in-person activities. Further, participating in these activities could increase your risk of contracting COVID-19.

Individual Responsibility to Minimize Your Exposure:

Attendees of RESOLVE Programs should take precautions to keep everyone safer from exposure, including the following:

  • RESOLVE encourages all attendees of in-person support groups to become fully vaccinated against COVID-19.  
  • If you have symptoms, test positive for COVID-19, and/or are exposed to someone with COVID-19, do not attend in-person RESOLVE support groups until after quarantining in accordance with CDC and your state and local health guidelines. You may participate in virtual support groups during this time.  
  • Follow federal, state, and local guidelines on COVID-safety procedures. 
  • Adhere to the safe distancing precautions established in areas. You understand that the CDC recommends social distancing of at least 6 feet. Limited physical contact is encouraged. 
  • Wearing a face covering may be required by the meeting venue’s COVID-19 protocols and according to your state and local health guidelines. If you decide not to follow the venue or state and local health guidelines, you may not be allowed to stay on property to attend the meeting. 
  • Take steps between groups to minimize your exposure to COVID. The COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. At this time, it is still difficult to determine who may have the virus and who does not.


RESOLVE may update these COVID-19 procedures periodically in accordance with public health guidance.  

9. Field Is Required I have read and agree to the above Peer-Led Support Group Guidelines, Waiver, and COVID-19 Safety Warning and Acknowledgement.
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