AUTHORIZATION FOR MENTORSHIP PROGRAM PARTICIPATION
American Transplant Foundation Living Donation Mentorship Program
I, or my authorized representative, request and authorize the American Transplant Foundation (ATF) to share my contact information with a volunteer mentor who has personal experience with organ donation to provide guidance and support during my transplant process.
I understand that:
1. This authorization is voluntary.
2. I have the right to revoke this authorization at any time in writing, except to the extent that action has already been taken based on this authorization.
3. Communications may be electronic, such as email, and such methods may not always be secure. There is no guarantee, assurance, or warranty of confidentiality.
4. I agree to hold the American Transplant Foundation and its officers, directors, employees, and volunteers harmless from any claims or liabilities that may result from electronic communications or my participation in the mentorship program.
5. ATF volunteer mentors share their personal experiences but do not provide medical advice. I am responsible for making my own informed decisions in consultation with qualified medical professionals.
6. ATF will make reasonable efforts to match me with an appropriate mentor but cannot guarantee that a suitable mentor will be available or that a mentorship relationship will be established.
7. Mentor-mentee relationships are informal peer support, not professional counseling or medical services. ATF does not guarantee compatibility, ongoing availability, or specific outcomes from mentorship relationships.
8. The mentorship relationship is voluntary and informal. Either the mentor or I may end the relationship at any time for any reason, with no obligation to continue. There is no expectation of ongoing availability or specific time commitment from either party.
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