Dravet Syndrome Patient Activity Room Registration

Sponsored by Ciara’s Light Foundation with support from Biocodex

Please complete the form below for participation in the Dravet activity room at the 2024 DSF Family & Professional Conference on June 21 & 22.  Please note that space is limited and we have a large number of DS patients attending this year, so we may not be able to accommodate everyone. 

Hours:
-Thursday:  Not open, but we will be at the conference registration area to meet your DS patient and answer any questions
-Friday:  8:30am – 6pm
-Saturday: 10am – 5pm

Music Together Classes will be available on Friday and Saturday on a limited basis. Please visit the Dravet activity room table at registration on Thursday to sign up for a class.

Please feel free to contact Lori directly if you have any questions at lori@ciaraslight.org

DSF Conference Patient Activity Room Registration

MM slash DD slash YYYY
CAREGIVERS WITH PATIENT IN ACTIVITY ROOM MUST BE AT LEAST 18 YEARS OLD. You can list more than one name if you will be switching caregivers throughout the two days.
In case of any emergencies
Will you be staying at the JW Marriott hotel? If not, please let us know where you are staying. *There may be a few little surprises sent to your room!
We will have some food/snacks available in the room. We may not be able to accommodate special diets based on our catering options, but we will do our best.
Please let us know of allergies to any food or anything else.
glue, paint, crayons, etc.
Color, Character, TV Show/Movie, Song, Activities, etc.
Likes/dislikes, things to avoid, etc.
Would they be interested in performing with us at dinner one evening?(Required)
Potential Participation Times(Required)
Please uncheck any times that you know your child will definitely not be participating in the activity room because you will not be at the conference or have other plans. Checking a box does not mean that you are required to participate during that time, but it will help us to plan how many potential kids to expect throughout the two days.
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