June Jessee Memorial Foundation · JJMF Holiday Family Event Registration

Sign-up for JJMF's Family Holiday Event

Saturday, December 16, 2023 at 2:30 PM The Lodge Des Peres 1050 Des Peres Rd, St. Louis, MO 63131

Parent/Caregiver Name

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First Name

Last Name

Parent/Caregiver Email

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Verify Email

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Parent/Caregiver Phone

*

Parent/Caregiver Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

# Adults Attending

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Please enter the number of adults in your family attending the event.

# Children Attending

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Please enter the number of children in your family attending the event.

Name(s) of children with neurological condition(s) attending.

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Date(s) of birth of children with neurological condition(s) attending.

*

Name(s) and age(s) of any siblings attending

Is there any information you would like to share with JJMF?

Media Permission

By taking part in this event, I grant the June Jessee Memorial Foundation full rights to use any images and video for fundraising and marketing purposes. If you do not wish to be photographed, please inform a JJMF staff member or volunteer.