Down Syndrome Partnership of Tarrant County

First Name:  Last Name: 

Mailing Address: 

City:  ST:  Zip: 

Preferred Phone Number: 

E-mail Address: 

Do you provide services (healthcare, education, etc.) to people with Down Syndrome?:
 Yes No

If “Yes”, please explain:

Name of child/relative with Down syndrome:
 

Date of Birth (MM/DD/YYYY):
 

If you would like to tell us a little about your child/relative, please enter it here:

Family members names, relation and ages of children, if applicable:

School district in which you reside:
 

If you are seeking specific information we may be able to provide, please let us know:

Are you interested in volunteering at a DSPTC event?:
 Yes No Maybe

Do you have an interest in serving on the DSPTC Board of Directors?:
 Yes No Maybe

How would you like to receive your newsletter?:
 E-mail Mail

How did you learn about DSPTC?:

We need to make sure you’re a real person. Please enter the numbers/letters you see below: