Become a member Membership is free! Name (of individual with DS) * First Name Last Name Gender * Date Of Birth MM DD YYYY Ethnicity Address School Phone * (###) ### #### Email * Diagnosis Before Birth * Yes No Relationship: * You are the person with Down syndrome Parent Sibling Grandparent Other Type of Down syndrome: Trisomy 21 Mosaic Translocation Unknown Health Please provide details about any medical conditions/health issues e.g. heart defect, colostomy, vision, hearing (if applicable) Guardian's Name * Guardian's Phone * (###) ### #### Guardian's Name Guardian's phone (###) ### #### Siblings Name & DOB: Consent * Please tick if you are happy for photos to be taken and used by the CDSA Yes No Thank you! Join the New Zealand Down Syndrome Association: Membership to the NZDSA is also FREE. To join, click here
