Please complete the information below. This will allow the DSAU to apply for grants to pay for more events and programs for you. We will ask you to update this information annually to help us keep it all current. Thank you for your cooperation and support!

Once you have completed this form be sure to scroll down and create your family membership login!

Name *

First Name

Last Name

Spouse/Partner

First Name

Last Name

Email *

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County *

Household Size *

Annual Household Income *

Diagnosis *

Currently Pregnant

Prenatal

Birth

Adopted Children

Foster Children

If currently pregnant, have you received a welcome basket?

(Program established 2024. Only applicable to families with children under 1 year of age)

Yes

Person with Down Syndrome *

First Name

Last Name

Person with Down Syndrome Birthday *

YYYY

Do you have more than one child with Down Syndrome? If so please list name(s) and DOB(s) below.

Ethnicity *

Sibling

First Name

Last Name

Sibling Birthday

YYYY

Sibling

First Name

Last Name

Sibling Birthday

YYYY

More children's name and DOB

Model Release *

Do you consent to you and your family's image being used in the materials of the DSAU?

Yes

Do you consent to email communication from the DSAU? *

Yes

I acknowledge that I can terminate my membership with the DSAU by submitting a written notice to the DSAU Board. *

Yes

Thank you!

Contact us at info@dsaupstate.org