The APSNA mission is that APSNA will be the voice that shapes pediatric surgical nursing through advocacy, collaboration, mentorship and leadership. Based on a foundation of research, education and innovation, APSNA will transform care delivery for pediatric surgical patients. This mission is the primary interest that will be prioritized in all APSNA activities. A conflict of interest thus compromises an individual’s accountability to APSNAs Mission and to those that APSNA aims to serve and risks erosion of the trust placed in APSNA to fulfill this mission. APSNA requires individuals subject to the Conflict of Interest Policy to read this policy, confirm receipt and agree to compliance, and to disclose all relevant interests, including, but not limited to financial relationships with entities that could be affected financially by the activities of APSNA, such as Pharmaceutical, Biotech, Food & Nutrition, and Medical Devices and Equipment companies, or foundations, advocacy groups, or other organizations supported by entities that may have a financial stake in the outcome. Public funding sources, such as government agencies or academic institutions need not be disclosed. Time period for disclosure is within 5 years from when this form is completed.

Please indicate below that you received a copy of APSNA’s IT RESOURCES AND COMMUNICATION SYSTEMS POLICY and that you read it, understood it and agree to comply with it. You understand that APSNA has the maximum discretion permitted by law to interpret, administer, change, modify or delete this policy at any time with or without notice. No statement or representation by an officer or director of, whether oral or written, can supplement or modify this policy. Changes can only be made if approved in writing by the board of directors of APSNA. You also understand that any delay or failure by APSNA to enforce any policy or rule will not constitute a waiver of APSNA’s right to do so in the future.

Please indicate below that you acknowledge that, you received and read a copy of the Nondiscrimination/Anti-Harassment Policy of the American Pediatric Surgical Nurses Association, Inc. and understand that it is your responsibility to be familiar with and abide by its terms. You understand that the information in this Policy is intended to help APSNA’s employees, directors, officers, members and volunteers to work together effectively on assigned responsibilities.

Please indicate below that you received and read the APSNA Statement of Values and Ethical Standards Policy and agree to abide by its terms.

Please indicate below that you have received a copy of the APSNA Board of Directors Attendance Policy, and that you have read and understand the policy and agree to comply with it.

Please indicate below that you received and read the APSNA Diversity and Inclusion Policy and agree to abide by its terms.

Please indicate below that you received and read the APSNA Bullying and Incivility Policy and understand the policy and agree to comply with its terms.

I, [insert name], a Board member of the American Pediatric Surgical Nurses Association Inc., declare that, in carrying out my duties as a director, I will: 1. Exercise the powers of my office and fulfill my responsibilities in good faith and in the best interests of the Association. 2. Exercise these responsibilities, at all times, with due diligence, care and skill in a reasonable and prudent manner. 3. Respect and support the Association’s bylaws, policies, Statement of Values and Ethical Standards Policy, and decisions of the Board and membership. 4. Keep confidential all information that I learn about any member or contracted agents, and any other matters specifically determined by board motion to be matters of confidence, particularly those matters dealt with during in person or teleconference meetings of the Board. 5. Conduct myself in a spirit of collegiality and respect for the collective decisions of the Board and subordinate my personal interests to the best interests of the Association. 6. Immediately declare any real or apparent personal conflict of interest that may come to my attention. 7. Immediately resign my position as director of the Association in the event that I, or my colleagues on the Board, have concluded that I have breached my ‘Oath of Office’. Please indicate below that you read the APSNA Governance Policy, understand the policy and agree to comply.

Please indicate below that you received and read the APSNA Social Media Policy and understand the policy and agree to comply with its terms.

Please indicate below that you received and read the APSNA Interactions with Industry Policy and understand the policy and agree to comply with its terms.

Please indicate below that you received and read the APSNA Brand Identity Policy and understand the policy and agree to comply with its terms.

Please indicate below that you received and read the APSNA Interactions with Industry Policy and understand the policy and agree to comply with its terms.

Please indicate below that you received the APSNA JPSN Editorial Board Policy, reviewed and understand the policy and agree to comply with its terms.

This policy provides guidelines for the expectations of the American Pediatric Surgical Nurses Association, Inc. (APSNA) Special Interest Groups (SIGs). APSNA SIGs are established to allow members to share common interests in an organized, formal manner and to act as a resource for the APSNA Board of Directors (BOD) and general membership. Please indicate below that you reviewed and understand the policy and agree to comply with its terms.

The purpose of this policy ensure that all requested SIG projects fulfill the American Pediatric Surgical Nurses Association, Inc. (APSNA) mission, are reviewed by an equitable process and that funding is distributed in a fair, transparent manner. Please indicate below that you reviewed and understand the policy and agree to comply with its terms.

Please indicate below that you have reviewed thee APSNA Connect and Forum Guidelines.