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NEW CONSTITUENT FORM
NUEVA FORMA CONSTITUYENTE EN ESPAGÑOL HAGA CLIC AQUÍ
SPOUSE/PARTNER'S PHONE NUMBER
ADDRESS- ( WRITE N/A IF NO ADDRESS AVAILABLE BUT THIS WOULD BE HELPFUL INFORMATION TO PLAN PLAY DATES IN AREAS WHERE OUR FAMILIES LIVE, AS WELL AS TO DROP OFF WELCOME/HOSPITAL BAGS IF NEEDED)
Address Line 1
Address Line 2
Select all that apply
Disabled Community Member
Parent/Guardian of someone with a disability
Loved One Information
Are you disabled? Write Self. Have a child or adult with a diagnosis you care for? Enter their diagnosis here. If not, write N/A
NAME OF LOVED ONE WITH DIAGNOSIS
DIAGNOSIS OF YOUR LOVED ONE
BIRTHDATE OF LOVED ONE WITH DIAGNOSIS
SCHOOL LOVED ONE IS ATTENDING
2nd Loved One Information
Have another child or adult with a diagnosis you care for? Enter their diagnosis here. If not, leave this section blank.
NAME OF SECOND LOVED ONE WITH DIAGNOSIS
DIAGNOSIS OF YOUR SECOND LOVED ONE
BIRTHDATE OF SECOND LOVED ONE WITH DIAGNOSIS
SCHOOL SECOND LOVED ONE IS ATTENDING
ANYTHING ELSE YOU'D LIKE US TO KNOW?
WOULD YOU LIKE TO HELP US CONTINUE TO CREATE COMMUNITY? CONSIDER DONATING TODAY!
HOW DID YOU HEAR ABOUT US?
WORD OF MOUTH
WHICH MEET UPS WOULD YOUR FAMILY BE INTERESTED IN ATTENDING?
This field is for families. If you are interested in volunteering, please find our volunteer form.
Family Meetups - meet up at different parks/places in Sonoma County
Moms' Meetups - just for moms to take a break and connect
Dads' Meetups - just for dads to take a break and connect
Siblings Support Group for siblings aged 2-6
Sibling Support Group for siblings aged 7+
New Family Support Group for families with children 0-3 years old - This group is run by a volunteer MFT who has a child with a rare diagnosis
Would you like to receive emails and the Monthly Newsletters from CGS?
Yes, I would like to receive emails and the newsletters from Common Ground Society™