Join Casey’s Friends

icons-02Please tell us a little about your child. This will help us to propperly match up children based on abilities and interest for any of our smaller events. We will include you and your family in ALL of the open events.

We do not share or sell any of this information, everything you provide in this form is strictly for our records!

Parent Information

Your Name: * Required
Your Email: * Required
Street Address:
Street Address 2:
City:
State:
Zip:
Phone: (555)555-1212
What is the best way to contact you?
Email
Phone
Mail

Child Information

Your Child’s Name (with special needs): * Required
Your Child’s Age: * Required
Tell us a little bit about your child- diagnoses, equipment used, etc. * Required
If your child is medically complex, please be sure to let us know so that we can include your child on our invitation only events designed for our medically complex families. If you are not sure if your child is medically complex CLICK HERE and refer to our complex questions.
If your child has a website, blog, facebook page, carepage, etc. please list it below.
Does your child have siblings?
Yes
No
If yes, please list out their names and ages.