DSAGC Volunteer Survey for Pre-Natal and Post-Natal First Call Outreach
After you have listened to the webinar regarding the First Call program, please respond to this survey to let us know your volunteer interests. Thank you.
Preferred e-mail address
Preferred phone number
Age of your child with Ds
0 - 3 years
4 - 6 years
7 - 10 years
Older than 10 years
Do you have children without Ds?
If so, how many children and what are their ages?
When did you receive your child's Ds diagnosis?
Post-Natally within a week after birth
Post-Natally more than a week after birth
If your child with Ds has any additional health concerns that you are willing to share, please list them here.
Did you have any pre-natal concerns or issues with any of your pregnancies?
Sometimes, cultural background/ethnicity/religion are important in making matches.
Please tell us about your heritage or religious beliefs, languages spoken or anything else that may be relevant. This is completely optional, but can make a difference.
What are your volunteer interests in regards to the Pre-Natal Program? (click all that apply)
First Call - Meeting with prospective parents after pre-natal Ds diagnosis
Medical Outreach - Delivering information to OBGYN offices
What are your volunteer interests in regards to the Post-Natal Program? (click all that apply)
Greeting new parents at the hospital
First Call - Meeting with new parents
Medical Outeach - Delivering materials to Pediatrician offices
If something was not listed above, please feel free to write it in here.
Any additional comments or questions?
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