New Parents Information Form

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Please complete the form below and send it to us. We'll respond right back to you. Thanks for your interest and we look forward to visiting with you soon

Mothers Name:

Fathers Name:  

Address:         

City:                 State:  Zip:

Telephone:      

Childs Name:   

Gender  Male:   Female:    Date of Birth:

PLEASE CHECK ALL APPLICABLE BOXES BELOW
I would like the visit to be with a mother.
I would like the visit to be with a father.
I would like the visit to be with a mother and a father.
I would like the visit to be with a mother, father, and child.
Child with Down syndrome ages 2 to 10 years.
Child with Down syndrome ages 10 to 20 years.
Child with Down syndrome ages over 20 years.
I would like the visit to be in my home.
I would like the visit to be in the home of a visiting parent.
I would like to have a phone visit.

I have the following concerns 

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Send mail to info with questions or comments about this web site. Last modified: June 14, 1999
Copyright © 1998 - 1999 Down Syndrome Parent Support Group of Genesee County, Inc.