Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Primary Language *

English

Spanish

Relationship to Individual with Down syndrome *

Parent

Sibling

Grandparent

Extended Family

Medical Professional

Self-Advocate with DS

School/Educator

Related Agency

Other

How Did You Hear About the DSG?

OBGYN

Pediatrician

DS Clinic

Other Medical Professional

Internet Search

Social Media

Word of Mouth

Educator

Other

Name

First Name

Last Name

Phone

(###)

###

####

Name *

First Name

Last Name

Date of Birth or Due Date *

MM

DD

YYYY

For New & Expectant Parents (Ages 0-1 Year)

I would like to receive a New & Expectant Parent Packet to the address above.

I would like to be contacted via email or phone by a First Call Family at the primary phone number above.

Release Approval *

I hereby grant the Down Syndrome Guild of Dallas permission to send me printed materials, emails and other information related to its mission. I understand that I may "opt out" of receiving any form of communication, at any time, for any reason.