Dedicate a Mile for Your FOXG1 Child
Thanks to a generous gift from David Cush, we are able to dedicate 250 miles of Tom Horton’s 500-mile Camino de Santiago walk to FOXG1 children who don’t yet have a mile dedicated in their name.
Please complete this form to have your child’s name included.

Reminder: Children must be registered in the FOXG1 Patient Registry to be eligible.
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Parent/Guardian Full Name *
Email address
Child's Full Name
Child's Date of Birth *
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DD
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Is your child enrolled in the FOXG1 Patient Registry
https://foxg1.beneufit.com/login.php
 *

Consent to Share

I give permission for the FOXG1 Research Foundation to share my child’s name in connection with this mile dedication.

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