TARS Family Connection Interest Form 💙
Share your details and preferences to connect with other families in the TARS community.
Parent/Guardian Name
*
First Name
Last Name
Email
example@example.com
Child’s Name
*
Child’s Age
*
Diagnosis/Condition
*
Location (City/State)
*
Preferred Contact Method
*
Email
Text
Facebook Messenger
Who do you feel comfortable connecting with? (Select all that apply)
*
Newly diagnosed families
Families with young children
Adults with TAR/limb differences
Local Texas families
Virtual only
What topics are you comfortable discussing? (Select all that apply)
*
Surgeries/hospital stays
Platelet challenges
School experiences
Adaptive living/tools
Emotional support
Community/social inclusion
Daily life experiences
Is there anything else families should know about you?
Would you like to remain active on the future support-family list?
*
Yes
Not at this time
Submit
Should be Empty: