Hosted by The Down Syndrome Connection of the
Bay Area and Opening Doors PTA

Time to Mingle and Jingle!!!

Parent's  Name

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* 1. Parent's  Name

Spouse's  Name (Write NA if he/she is not attending)

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* 2. Spouse's  Name (Write NA if he/she is not attending)

Child's Name (write NA if child will NOT be attending)

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* 3. Child's Name (write NA if child will NOT be attending)

Child's Date of Birth

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* 4. Child's Date of Birth

Month/Date/Year
Will his/her siblings be joining?

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* 5. Will his/her siblings be joining?

What are their names and ages? (Write NA if there are no siblings)

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* 6. What are their names and ages? (Write NA if there are no siblings)

I hereby waive and release all claims against the Down Syndrome Connection of the Bay Area (DSCBA) which arises from my participation in and travel to and from the DSCBA programs. I also authorize the use by the DSCBA of any photos, film or video taken of me or my child during the group and or class for use on DSCBA social media pages, website, publications and grant proposals and reports. 

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* 7. I hereby waive and release all claims against the Down Syndrome Connection of the Bay Area (DSCBA) which arises from my participation in and travel to and from the DSCBA programs. I also authorize the use by the DSCBA of any photos, film or video taken of me or my child during the group and or class for use on DSCBA social media pages, website, publications and grant proposals and reports. 

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