Membership Type Zero Foundation

Type Zero Foundation Membership

Creating everyday support for families with diabetes in Central FL
Dear New Family,

Welcome home! Once you fill out this application, a volunteer will reach out to schedule a Zoom call to meet you and provide any resources that you need. After that, you're welcome to utilize all of the services our volunteers have put together for our families impacted by diabetes. We look forward to getting to know you and supporting you on your health and wellness journey. You are not alone!
Your Name*

First NameLast Name
Best Email to Send Resources & Updates*
example@example.com
Your Phone Number*
Residence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total Number of Family Members Registering for Membership*
Type of diabetes you/your family need support for*

Type 1 diabetesType 2 diabetesGestational diabetesOther
Approximately when did the first diagnosis take place?*

MonthDayYear
Date
Most immediate needs*

Access to diabetes medicationsAccess to health insuranceDiabetes educationDiabetes supportFinancial assistance for housing, food, etc.Other
Which free support services would interest you and your family?*

Dance & sport classes through income sliding scale (available to children 4yrs+ and adults)Parent yoga classesMoms/Grandmas/Caregivers small groupDads/Grandpas/Caregivers small groupYoung adult small groupDia-Elf Project visit (surprise home visit at Christmas from elf with diabetes)Member events (Diabetes Ninja Night, weekend retreat, Day at Fun Spot amusement park, etc.)Volunteering and helping other new families
Let us know if you or any family members have other needs. We will connect you with members who have these in common with you:

Youth autism/neurodivergenceAdult autism/neurodivergenceOther autoimmune disease(s)
Name/Age/Interests of Family Members with Diabetes*
Who referred you to us?*
Should be Empty:

Type Zero Foundation Membership

Dear New Family,