Application for Membership

Child full name *

First Name

Last Name

Child's primary address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

My child has Down syndrome *

Yes

Primary parent /guardian name *

First Name

Last Name

Other parent/guardian name

First Name

Last Name

Speech and language therapist name

First Name

Last Name

How did you hear about UpsideDowns? *

Tick all that apply

Word of mouth

Social media (e.g. Facebook, Twitter, Instagram, YouTube)

News Media

UpsideDowns Event (e.g. Quiz Night, Share the Dream)

Other Down Syndrome Organisation (e.g. NZDSA)

Medical Professional

Ministry of Health Speech Therapist

Ministry of Education Speech Therapist

Private Speech Therapist

School/ECE Centre

Other

I consent to UpsideDowns using this information for the purposes of administering the Trust *

Yes

I have read, understood, and agree to the Terms and Conditions of UpsideDowns membership *

Click to view Terms & Conditions

Yes