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* 1. Primary Parent/ Legal Guardian Contact Information

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* 2. How did you hear about DSACT?

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* 3. Place of Employment (this question will help DSACT obtain matching donations)

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* 4. Job Title

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* 5. How do you prefer for DSACT to first reach out to your family?

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* 6. Would you like to join our mailing list to receive our newsletter and event updates?

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* 7. Additional Parent/ Legal Guardian

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* 8. Place of Employment (this question will help DSACT obtain matching donations)

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* 9. Job Title

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* 10. Name of Individual with Down syndrome

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* 11. Date of Birth of Individual with Down syndrome

DOB

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* 12. Name of Sibling 1

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* 13. Date of Birth of Sibling 1

DOB

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* 14. Name of Sibling 2

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* 15. Date of Birth of Sibling 2

DOB

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* 16. First and Last Name and Date of Birth of Additional Sibling(s)

TO HELP US BETTER UNDERSTAND OUR MEMBERSHIP AND ASSIST OTHER PARENTS, PLEASE FILL OUT THE FOLLOWING VOLUNTARY INFORMATION.

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* 17. Hospital where child with Down syndrome was born.

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* 18. City where your child with Down syndrome was born.

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* 19. State where your child with Down syndrome was born.

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* 20. Timing of diagnosis?

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* 21. Please list any additional medical conditions.

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* 22. At the time your doctor first told you that your baby has, or likely has, Down syndrome, did your doctor give you this information about Down syndrome from the state website? Information about Down Syndrome for New and Expecting Parents

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* 23. At that time, did your doctor give you any other information about Down syndrome? Please select all that apply.

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* 24. If someone other than a doctor first told you that your baby has, or likely has, Down syndrome, who was that person:

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