Local Connections Form
Who is this form for?
This form is for families who would like to find connections in their local area. By filling out this form, you are giving DSDN permission to use your information to facilitate a local connection on your behalf.
What type of local connections are you seeking?
Finding a local organization
Finding a family near me
How old is your child?
Do you have a specific connection request? (find another family whose child is same age, has the same heart defect, find a family of same religion, etc.)
How would you like this connection to be made?
Through a group email introducing me to the connection
Giving my phone number to the connection
Have the local organization mail me information
I understand that I am authorizing DSDN to connect me to another family or organization. By doing this, I understand that DSDN will be sharing my personal information.
Signature (Type Name)
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