CMDSS Member Registration
Your Name
Today's Date:
Your Email Address:
Name of person with Down syndrome
or Special Needs:
Relationship to you:
Address:
City:
State/Zip
Phone number
:
Favorite Things:
Special Needs:
Special Talents:
Mother's Name
DOB: mm/dd
cell phone:
Mother's Email Address:
Best time/way to reach:
mother's occupation
Father's Name:
DOB: mm/dd
cell phone:
Father's Email Address:
father's occupation:
Best time/way to reach:
Sibling:
DOB:
Sibling:
DOB:
Sibling:
DOB:
Sibling:
DOB:
How you would like to benefit from CMDSS:
What activities would you like to see
CMDSS provide?
How active would you like to be in CMDSS?
Additional Comments:
How did you hear about CMDSS?