Family Topic Group Sign-Up

Family Topic Group Sign-Up

Thank you for your interest in the chILD Foundation's Year 2 Family Topic Groups! These groups meet monthly from September 2026 through January 2027 and are organized by chILD diagnosis type. Please complete this short form and we will be in touch about placement.
Section 1: About You
Name

First NameLast Name
Email
example@example.com
State/Province

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Section 2: Your role
I am a... (select one)

Other
If you are a patient aged 13-17 please answer the following:
Parent/Guardian name and Email
Section 3: chILD Diagnosis

Please select the diagnosis group that best fits your family. This will be used to place you into the correct group and will not be shared unless you give us written permission.
What is your (or your child's) chILD Diagnosis? Select one.

Other
Section 4: Additional Information
How did you hear about this opportunity?
Would you like us to add you to our mailing list to hear more about chILD Foundation activities?
Is there anything else you'd like us to know about your situation or your interest in participating?
Should be Empty:

Section 1: About You