• Format: +1 (000) 000-0000.
  • Birthdate*
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  • Address

  • Dietary Restrictions (please check all that apply)*
  • Languages Spoken*
  • Ethnicity (check all that apply)
  • Do you have any personal connections to type 1 diabetes?*
  • Please select all that apply*
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  • Which of the following best describes your current role in education?*
  • What type of educational setting do you work in?*
  • Is your school a Title 1 school?*
  • Update Contact - HCP*
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  • Please take a few moments to answer the following questions about your current understanding of type 1 diabetes in the school setting. There are no right or wrong answers, we simply want to understand what your experience supporting students with type 1 diabetes is.

  • Have you ever shared information with parents about screening for type 1 diabetes?*
  • Have you received any formal training on type 1 diabetes?*
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    • Photo and Video Release 

    • Photo and Video Release
      I grant permission to Touched by Type 1, its partners, and event sponsors to photograph, record, and/or film me and any minor for whom I am registering during the event. I understand that these images or recordings may be used by Touched by Type 1 for educational, promotional, marketing, or fundraising purposes, including use on websites, social media, printed materials, and other media platforms, without compensation.

    • Release of Liability 

    • Assumption of Risk and Release of Liability
      Participation in this event is voluntary. I understand that there may be inherent risks associated with participation in community events and activities. I voluntarily assume all risks associated with my participation and the participation of any minor for whom I am registering.

      By completing registration and signing below, I acknowledge that I have read, understand, and agree to this Participant Waiver and Release of Liability.

    •  
    • I consent to sharing my registration information (specifically, my name and email address) with Touched By Type 1’s trusted partners and sponsors, like Tandem Diabetes Care, Inc. so that I can receive product-related follow-up and informational emails.
    • I agree to receive occasional automated event related marketing text messages from Touched by Type 1 at the phone number provided. Consent is not a condition to register. Msg & data rates may apply.*
    • Marketing Consent
    • Form Language*
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