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CBTF/Next Step Virtual Weekend Campference

Name: CBTF/Next Step Virtual Weekend Campference
Start: 2021-02-25T00:00:00-05:00
End: 2021-02-27T23:59:59-05:00
Location: Online

February 25 - February 27

Free

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Please join us for a joint Next Step/CBTF Virtual Campference just for you!

This three-day virtual event will provide workshops to gain confidence in your sense of self, learn positive self-talk, and explore concrete skills to apply on a daily basis.

If you are interested in community engagement and are willing to step into your stretch-zone, we hope to provide you with tools to speak up for yourself, advocate for your own needs, and connect with other brain/spinal tumor survivors who get it.

Let’s get together for some fun and learning!

Virtual Weekend CBTF/Next Step Campference 2021

Next Step/CBTF Virtual Weekend for young adults, ages 18-29, living with a brain or spinal cord tumor experience.*
- February 25-27
The exact timing of the workshops is still TBD. We are trying to accommodate those with work/school conflicts. For more info please call Quita at 617-852-4236
Name*
First Last
Have you been on a Next Step program before?*
- Yes
- No
How did you hear about the Next Step Weekend?*
- Website
- Another Participant
- Medical Staff
- Social Media
- Other
If medical staff, please include name, position and hospital:*
Your Preferred Name/Nickname
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Alternate Phone
Email*
Preferred mode of contact?*
- Email
- Cell Phone (Call)
- Cell Phone (Text)
Current Occupation
Employer or School
Age
Birthday*
Date Format: MM slash DD slash YYYY
Gender
Hospital or Clinic where you receive medical care?*
What do you hope to get out of the Next Step weekend experience?
What topic(s) do you most want to learn about at the weekend?
PARENT/GUARDIAN AND EMERGENCY CONTACT
Name*
First Last
Relationship
Phone
Email
Medical Overview
Allergies & Reactions
We might send care packages out and need to know of any known allergies.
If you having a conversation with a friend, how would they know you were not doing well medicall? How would you want them to support you?
At virtual campference, we like to create a safe space for "real conversations". The following questions will help us support you in that space.
Do you have a past history of experiencing challenges with managing your emotions during high stress or emotionally difficult times?
If yes, can you describe what that looks like/consists of for you (shutting down, self-harm, drinking, smoking, violence, etc.)
When you start to feel these intense emotions, what healthy strategies do you find are helpful for dealing with those?
CONSENT AGREEMENT
AUTHORIZATION AND RELEASE This Consent Agreement, Authorization and Release must be read and signed to be eligible to attend Next Step's Young Adult Campference. Since Next Step's campferences will be virtual this year, they will fall into the category of a virtual telehealth experience. I consent to engage in a virtual telehealth campference. I understand that a telehealth format can include using interactive audio, video, or data communications, emails, or telephone conversations. I understand that during the virtual campference there may be direct or indirect communication of my medical information, both orally visually.
Please indicate:*
- I consent
- I do not consent
Community Agreement/Rules of Conduct
The young adult campference is a close-knit community; therefore we ask that you agree to a few things that will promote being together in a safe manner. Please sign this Community Agreement, which asks that you agree to conduct yourself ethically and respectfully while living in the program:*
- 1. Delegates are to demonstrate a high degree of maturity and self-respect, taking into account the rights and feelings of others.
- 2. Delegates should not be under the influence of alcohol or illicit substances while participating in the virtual campference.
- 3. Delegates are to be present at all times during workshops - i.e. not engaging in any other conversations or activities (virtually or physically)
- 4. Delegates agree to maintain an environment that is private and free from distractions - (as much as you can control)
- 5. Delegates are to adhere to the virtual campference schedule- showing up on time for scheduled workshops and activities.
- 6. Delegates are expected to attend all scheduled virtual campference activities.
- 7. Suitable attire is to be worn during virtual campference workshops and activities.
Please select as an indication that you will adhere to the code of conduct.
The Following Behaviors are grounds for Immediate Dismissal:*
- 1. Bullying. As defined as unwanted, aggressive behavior that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. Verbal bullying is saying or writing mean things. Social bullying involves hurting someone’s reputation or relationships and can include leaving someone out on purpose, telling other’s not to be friends with an individual, spreading rumors, embarrassing someone.
- 2. Missing more than half of the mandatory, scheduled virtual campference activities without prior approval or checking with Next Step staff
- 3. Being inebriated during virtual campference activities.
Please select as an indication that you understand the behaviors that are unacceptable at the program.
Please indicate:*
- I agree to the community agreement
- I do not agree to the community agreement
PHOTO AND INFORMATION RELEASE
I give Next Step permission to photograph and use pictures or visual and/or audiotapes of me in professional or fundraising activities. On occasion, with this permission, participant photographs may be included on the Next Step website, on a bulletin board, video, newsletter, campference album, or in personal photographs. Next Step respects the privacy of participants and does not allow unauthorized visitors to photograph the campference or participants. In addition, by signing below, I give Next Step permission to give my name, address and/or phone number to groups or individuals wishing to support Next Step by inviting me to an event or by sending me information related to Next Step. This list will not be sold or given to anyone else for any other reason.
Please check appropriate box and provide your signature below:*
- I agree to the photo release
- I do not agree to the photo release
Please Sign
By signing below, I hereby acknowledge that I have read and fully understand the terms and expectations of the program. All information provided is current and accurate to the best of my knowledge.
Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
Please check this box to indicate that the above signature will serve as your electronic signature
- (Delegate or Legal Guardian if the Delegate is not over the age of 18)

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Details

Start:: February 25
End:: February 27
Cost:: Free
Event Categories:: Cancer, Program
Event Tags:: Brain Tumor, campference, cancer, community, spinal cord tumor

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Online

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CBTF/Next Step Virtual Weekend Campference

February 25 - February 27

Virtual Weekend CBTF/Next Step Campference 2021

PARENT/GUARDIAN AND EMERGENCY CONTACT

Medical Overview

CONSENT AGREEMENT

Community Agreement/Rules of Conduct

PHOTO AND INFORMATION RELEASE

Please Sign

Details

Venue

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Experience
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