Register – Family Membership – Down Syndrome Association of Hamilton

This annual membership is for families or households where an individual under the age of 18 has Down syndrome. Families with adults over 18 living at home may also register. This membership includes all members of the household.

Parent Guardian Name 1 *
First
Last
Parent 1 Email *
Phone number *
Parent/Guardian 2 (Optional)
First
Last
Parent 2 Email (Optional)
Individual with Down syndrome under 18 *
First
Last
Sign up for the Birthday Club *
Yes
No
Individuals with Down syndrome can receive a special surprise on their birthday!
Individual with Down Syndrome Birthdate *
(mm/dd/yy)
Sibling Information (optional)
Siblings can take part in our programming too!
Sibling 1: Name & DOB
Include any siblings under 18
Sibling 2 Name & DOB
Include any siblings under 18
Sibling 3 Name & DOB
Include any siblings under 18
Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Country
Memberships are for Ontario, Canada residents only.
Additional Information
The following four sections are optional. The information collected helps us to plan programs and events based on members needs and interests. The information you provide is confidential and will not be shared with third parties.
Allergies or Medical Conditions (Optional)
Special Dietary Conditions (Optional)
Additional Physical or Emotional Support Conditions (Optional)
Child's interests (Optional)
Photography/Video Consent
Yes
No
I allow myself and individuals in my household to be photographed at DSAH events and programs. Photos and videos are property of the Down Syndrome Association of Hamilton and used for social media, marketing and educational purposes only. You may change your selection at any time.
By signing, I agree to the holding of this information and understand the Down Syndrome Association of Hamilton will not pass information onto third parties without prior permission. The information I have provided is correct as of the date signed.

Signed *

Clear Signature

Date *
Select Membership Type *
Family Membership - $25.00
ADMIN ONLY - $0.00
Payment - Credit Card *
Card
Name on Card
ADMIN ONLY NOTES
When complete, click 'submit'. Only click once and do not refresh the page. Check your email for confirmation of payment.