Teen Pain Warriors – Chronic Pain Support Group

A monthly group for 13-17 years old with chronic pain. This group meets on the 3rd Wednesday of the month from 7-8PM ET and will be facilitated by Dr. Melissa Geraghty (Dr. G), Director of Mental Health and Support, and Sara Gehrig. You can contact Dr. G for more information at dr.g@uspainfoundation.org.

Parents/guardians are required to read and respond to the following Consent Form for all minor participants, please copy and paste this link to view: https://forms.gle/wzh7CtqWmu3oCedA8

Pain Connection is a support group program of the U.S. Pain Foundation. All support groups leaders have gone through our training program, where they learn to guide productive, compassionate discussions amongst participants. They are also trained in helpful techniques, like meditation, breathing exercises, guided imagery, decision-making models, role-playing, assertiveness skills, and more.

All discussions in Pain Connection groups are confidential, and designed with your comfort in mind. For example, you should feel free to lie down during groups.

Currently, all groups are meeting via Zoom. To register please fill out the form on this page and an email confirmation will be sent to you with a zoom link.

If you have questions about our support groups, or are interested in starting one in your area, please reach out at contact@uspainfoundation.org.

Teen Pain Warriors - Chronic Pain Support Group

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Days: 3rd Wednesdays of the month
Time: 7-8pm ET
Contact: Dr. Melissa Geraghty and Sara Gehrig at contact@uspainfoundation.org

In order for your minor child to participate in the Teen Pain Warriors - Chronic Pain Support Group, we need your consent and involvement in helping your child have a productive and safe experience. This is an educational/support group, not a medical/therapy group. It is limited to minors aged 13 to 17. Please carefully read and sign this parental consent and waiver of liability.

If you have any questions or would like further information, please email Dr Melissa Geraghty, director of mental health and support, at dr.g@uspainfoundation.org.

Name of Child*

Address*

Birthdate of Child*

Child's Phone Number*

Child's Email Address*

Enter Email Confirm Email

Name of parent/guardian*

First Last

Relationship to child*

Phone number of parent/guardian*

Email address of parent/guardian*

Waiver and Release*

Please scroll through entire waiver and read before confirming that a guardian has provided consent to allow any minor under the age of 18 to attend these meetings and accept its terms.

I, the undersigned, on behalf of my minor child and myself, hereby represent and agree as follows:

I certify that I am the parent or legal guardian of the minor child (named above) and that I have the right to make decisions for my child that affect his/her/their wellbeing. I understand that my child will be a participant in the Group and I hereby give permission for my child to participate.

I understand that the Group will include discussion of healthcare, school, social and family issues and the management of chronic pain and that the level of my minor child’s participation in the Group and any Group activities must be determined by me, in consultation with my minor/child’s physician or other qualified healthcare provider.

I further understand that the Group leaders are volunteers and people with pain who have undergone training with U.S Pain Foundation, Inc. and that they are not physicians, psychiatrists, psychologists or other trained medical practitioners. U.S. Pain Foundation, Inc. is dedicated to serving those who live with pain conditions and their care providers but does not advocate any one particular treatment for any one type of pain.

I acknowledge that the Group leaders and/or U.S. Pain Foundation, Inc., by making this group available, are not undertaking any responsibility regarding my minor child’s medical condition(s). If I feel that his/her/their medical condition(s) are adversely affected by participation in the Group, l understand that it is my responsibility to discontinue my minor child’s participation and to immediately consult with his/her/their healthcare provider about continuing or resuming 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 my minor child and/or any participants in the Group and/or U.S. Pain Foundation, Inc. to any other party whatsoever.

I hereby, on behalf of my minor child, myself, our heirs, executors, administrators, and assigns, assume the risks associated with my minor child’s participation in the Group and release, indemnify and hold harmless the group leaders, U.S. Pain Foundation, Inc. and it’s agents, officers, members, volunteers and employees from any and all claims, demands, for personal injuries, costs, expenses, and any other loss to person or property that I or my minor child may suffer or have which arise out of or result from my minor child’s participation in the Group.

I have read this parental consent and waiver of liability, I have been given the opportunity to ask any questions, and I fully understand and agree to the above.

I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER AND THAT I HAVE READ, FULLY UNDERSTAND AND AGREE TO THE TERMS OF THIS PARENTAL CONSENT AND WAIVER OF LIABILITY, AND I SIGN IT VOLUNTARILY WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.*

Yes

Legal Guardian's Name*

First Last

Date consented*

How did you hear about us?*

Do you want to join the Pain Connection mailing list?*

Yes

Would you like monthly reminders of support group meetings?*

Yes

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Group Leader Email

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Day

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Time

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Zoom Link

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Google Add to Calendar

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Meeting ID

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Passcode

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zoom phone

Unique ID

This field is for validation purposes and should be left unchanged.