Register – Self Advocate Membership – Down Syndrome Association of Hamilton

This membership is for individuals with Down syndrome who live in Ontario, Canada and are over the age of 18. Programs and events take place in Hamilton, Ontario.

Member Name *

First

Last

The person over 18 with Down Syndrome

Phone *

Member Email

Parent/Guardian 1 *

First

Last

Parent/Guardian Email *

Individuals with Down syndrome can receive a special surprise on their birthday!

Individual with Down Syndrome Birthdate *

We use this information to plan programs and events and if you opt into the Birthday Club.

Sibling 1 Name

First

Last

*Only include any siblings under 18

Sibling 1 Age

Sibling 2 Name

First

Last

*Include any siblings under 18

Sibling 2 Age

Sibling 3 Name

First

Last

*Include any siblings under 18

Sibling 3 Age

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 section is optional. The information provided helps us to plan programs and events based on members needs and interests. The information provided 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)

Your interests (Optional)

Photography/Video Consent *

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 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 *

Self Advocate Membership - $0.00

Free for individuals with Down syndrome over the age of 18. Membership is valid from January 1 to December 31st of the year.