Most Mentees request the following type of support. Please select which areas you would be comfortable helping a Mentee. Check all that apply

What are your preferred contact times - Weekends

NOTE: By uploading a photo, I hereby consent to the use of my name and likeness, for the sole purpose of promoting organ donation. I understand that the use of my name and likeness may include, but not be limited to photographs, newspaper articles, brochures, displays, television, radio, or any other public community relations material. I hereby acknowledge that this authorization is volunteered without obligation of any kind on the part of the American Transplant Foundation, its employees, and designated agents. This authorization is given without hope or expectation of reward or compensation of any kind. I hereby waive my right to inspect or approve any materials which may from time to time be created by the American Transplant Foundation and which may include my name, image, photo, likeness, or voice. I, together with my heirs, assigns, agent, guardians, and legal representatives hereby release the American Transplant Foundation from any and all claims, liabilities, and losses that may arise from its use of my name image, photo, likeness, and voice.

I understand that as a Mentor participating in the American Transplant Foundation (ATF) 1+1=LIFE Peer Mentorship Program, any advice I provide in the course of the mentoring relationship is solely for the purpose of guiding the Mentee in his or her transplant experience. I understand this relationship is designated to be a resource to discuss general issues regarding the transplant process, as well as to provide guidance, friendship, and emotional support. I understand that the Mentee will not rely upon my advice and/or statements as medical advice and that any advice I give will not be relied upon by the Mentee as a substitute for his or her own independent judgment. I agree that I will not recommend or endorse any specific medical or non-medical tests, physicians or other medical providers, products, or procedures, or otherwise give medical advice to a Mentee. I also agree that I will not offer the Mentee any financial or professional assistance. I understand and acknowledge that I am volunteering to participate in the 1-to-1 Peer Mentorship Program, that I do not receive any compensation for my participation, and that I am not an employee or agent of ATF nor do I represent ATF in any capacity. I agree to not share any of the Mentees personal or private information with anyone outside of ATF without the Mentees permission. I further acknowledge that ATF does not have any direct involvement in the mentoring relationship once a match is made. Because all aspects of the mentoring relationship are solely under the Mentor and Mentees control, I waive any claims against ATF, its officers, directors, member, employees, and/or agents relating to the 1+1=LIFE Peer Mentorship Program. I agree that in no event will I file a lawsuit or other action or otherwise attempt to hold liable ATF, its officers, directors, member, employees, and/or agents for any damages that may result from my participation in the 1+1=LIFE Peer Mentorship Program.

If the Mentor is a minor, the undersigned Parent/Guardian agrees that he/she has read the “Mentor Disclaimer and Release” and understand and agrees to ATF s policies relating to the 1+1=LIFE Mentorship Program. The Parent/Guardian consents to the minor s participation in the 1+1=LIFE Peer Mentorship Program.