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Thank you for referring a family to DSAL! 

By submitting this form, you confirm the family has given permission to share their contact information so we can reach out and provide support, resources, and connection.

Only your information and the parent/guardian’s name and contact details are required.
Additional information is helpful but optional.

We aim to connect with families within 24–48 hours.

Referral Source - Contact Information
Prefix
First Name *
Last Name *
Preferred Method of Contact

 

Please share the family’s contact information so our team can reach out and offer support.

Parent/Guardian #1 - Contact Information
First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code
Parent / Guardian #2 - Contact Information
First Name
Last Name
Individual with Down Syndrome
First Name *
Last Name *
Diagnosis Type
Current Life Stage
Does this person have siblings?
Additional Information
Please indicate the type of support DSAL may offer at this time.
Please check any immediate medical concerns if applicable
Ideally we would like to connect this family with another family who has handled a specific challenge (ex. our "heart babies" will be connected with other "heart families.")

DSAL will reach out with care and respect—families are never added to lists without consent.