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TnGEmByzoSqsDwfUoTxFcEkfpLRiGCys3Hy

Caregiver Workshop Registration Form

Dear Caregiver,

Thank you for your interest in the Transition Planning for Caregivers Workshops!

Our next workshop is for caregivers of children with intellectual disability who will require guardianship when they turn 18.

This event will be held on Thursday, December 15th from 10:00am-12:00pm via Zoom webinar.

Featuring:

Overview of transition basics
Guardianship process
Professional panel
Patient/Family Experience

Please complete the registration form below. You will be sent a confirmation email and closer to the event you will receive a link to access the webinar.

If you have any questions or concerns, please email SWTransition@childrens.harvard.edu or call Kerry McDonnell at 617-355-7482.

Thank you!

First Name

* must provide value

Last Name

* must provide value

Address

* must provide value

City

* must provide value

State

* must provide value

Zip

* must provide value

Preferred method of contact

Phone E-mail

Is it okay to leave a voicemail message?

Yes No

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Phone Number

* must provide value

Will another caregiver be logging into the workshop?

Yes

reset

First Name

Last Name

Relationship to the child

First Name

* must provide value

Last Name

* must provide value

MRN (if known)

DOB

* must provide value

M-D-Y

Please list the conditions that bring your child to Boston Children's Hospital (BCH)

* must provide value

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Please let us know the BCH clinics and/or departments in which your child is seen

* must provide value

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Please select which workshop this registration form is for

* must provide value

Intellectual Disability (ID) on Thursday, December 15th, 2022

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Intellectual Disability Flyer

Attachment:

Transition Flyer - ID (12.15.22).pdf

Please let us know how you heard about the workshop

* must provide value

Hospital Facebook page

Posted flyer

Social Worker

Medical team member

Mailing

Other

Person(s) name

Please specify

What do you hope to gain from this training?

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We invite you to submit a question that will be considered for our professional panel to discuss

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We are considering offering this zoom in a format where all participants would have the option of joining with their camera on. Is this something you would be interested in?

* must provide value

Yes

Additional Comments

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