Clone of BA DAY at Children's Mercy - Event Registration Form

BARE Presents BA Day!

Please complete form below to the best of your ability. Accurate information allows us to best prepare for a productive & enjoyable event!
Full Name

First NameLast Name
E-mail
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Which BA Day are you planning on attending?
Which stakeholder group do you best identify with?
Are you part of the BARE Connection Network (BCN)
Would you be interested in participating in a short interview with our media team? This could consist of sharing your story or answering questions
Attendee Information

Please complete the below to the best of your ability. Understanding the demographic of people who will attend allows us to better plan topics, staff appropriately & format the agenda for the uniqueness of the group. Thank you for your detailed responses!
What is the name of the institution/center you are affiliated with?
TOTAL Number of people attending in your group
Below is an example for a family of 5, with 2 parents, 1 child and 1 teen/adolescent
Number of CHILDREN (under the age of 18) attending in your group - this helps us understand activity need
Example: 1
Number of ADULTS attending in your group
Example: 2
Will your child(ren) like to participate in the kids activity area?
**Children under the age of 5 will need a caregiver/adult to accompany them to ensure all needs are met.
Does your TEEN wish to participate in sessions or the kids activity area?
Understanding the interest of the adolescent/teen allows us to plan accordingly and ensure they are included in sessions or additional programming.
What is the status of the BA patient in your group?
Age of BA Patient
Please list any food allergies for any member of your group
This is outside of transplant specific dietary restrictions such as grapefruit, pomegranate, etc... Type either NO or N/A if there are no allergies.
Optional Questions, Topics/Discussion Points & Photo Opportunity
OPTIONAL: Do you have specific questions, areas of interest or topics you would like asked or discussed?
Understanding questions or topics the community is most interested in allows us to build our programming around relevant topics for the group!
Complete Registration
By registering for and attending BARE ON THE ROAD: BA DAY, you acknowledge and agree to the following:I understand that photographs and/or video recordings may be taken during the event for promotional, educational, and archival purposes. By participating in this event, I grant the event organizers permission to use my likeness in any photo, video, or other media in connection with BARE ON THE ROAD and its related programming.I waive any right to inspect or approve the final use of such media, and I understand that these materials may be used across digital platforms, print publications, or other media outlets without compensation to me.If I do not wish to be photographed or recorded, I will notify the registration staff upon arrival.By registering, I confirm that I have read and understood this waiver.
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BARE Presents BA Day!

Attendee Information

Optional Questions, Topics/Discussion Points & Photo Opportunity

Complete Registration