Shine Bright by Making a Difference

Jonell’s Journey Support Group Participant Application

Thank you for your interest in joining our breast cancer support group. Jonell’s Journey is committed to providing a safe and supportive space for individuals affected by breast cancer. Please complete the application below, and we will be in touch soon.

Name

Date of Birth

Phone Number

Email Address

Mailing Address

Emergency Contact

Relationship

Emergency Contact Phone

Support Group Participation Are you:

Other

How did you hear about our support group?

What do you hope to gain from participating?

Do you have any specific topics or concerns you’d like to discuss?

Preferred Meeting Format:

Preferred Meeting Times:

Do you require any accommodations to participate?

Confidentiality Agreement :

Jonell’s Journey is committed to maintaining a safe and private environment for all participants. By signing below, you agree to respect the confidentiality of all group discussions and personal information shared by members.

Signature

“Strength is found in unity, hope grows through support, and love heals even the toughest battles.”

Privacy Notice for Jonell’s Journey

Jonell’s Journey is committed to protecting the privacy of all individuals who participate in our breast cancer support group. We value your trust and handle your personal information with the utmost care and confidentiality.

Information We Collect

We may collect personal information, including but not limited to:

Name, contact details, and demographic information
Health-related information you choose to share
Communications and interactions within the support group

How We Use Your Information

Your information is used solely to:

Provide support and resources tailored to your needs
Facilitate group discussions and community engagement
Improve our services and outreach efforts

Confidentiality and Sharing

We do not sell, share, or trade personal information with third parties.
Discussions within the support group are confidential, and we encourage all members to respect one another’s privacy.
If any data is shared for research or awareness purposes, it will be anonymized unless explicit consent is given.

Data Security

We take appropriate measures to protect your personal information from unauthorized access, disclosure, or misuse.

Your Rights

You have the right to:

Access, update, or request the deletion of your personal information
Opt-out of communications at any time
Express concerns about privacy practices

For any questions or to make a request regarding your personal information, please contact us at [email protected]

Your privacy is important to us. Thank you for being a valued part of our support community.

Frequently Asked Question.

Find answers to common questions about Jonell’s Journey, participation, volunteering, and support services.

Shine Bright by Making a Difference

Jonell’s Journey Support Group Participant Application

Frequently Asked Question.

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