Application & Membership Information

Application Date:

Application Type *New MembershipMembership RenewalChanges for Directory

Parent/Guardian Information

Parent 1

First Name

Last Name

Email

Home Phone

Cell Phone

Are you of Hispanic or Latino descent?YesNo(Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture)

Language(s) you speak

Parent 2

First Name

Last Name

Email

Home Phone

Cell Phone

Are you of Hispanic or Latino descent?YesNo(Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture)

Language(s) you speak

Mailing Address

Address *

City *

State *

Zip Code *

Individual with Down syndrome's Information

First Name of Individual with special needs *

Last Name of Individual with special needs *

Date of Birth of Individual with special needs *

Current Age

Relation to applicant: *

Are they Hispanic or Latino descent?YesNo(Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture)

Language(s) they speak

Additional Family Member(s) Information

Full Name

Age

Full Name

Age

Full Name

Age

Full Name

Age

Forms & Waivers

Please download, complete, and upload the following forms and waivers before submitting your membership application. If you have trouble uploading them, you can email them to us at dsosn@dsosn.org.

Emergency Contact Form

Hold Harmless Agreement

Media Waiver

Please upload each form separately in the format: Last Name, First Name_Name of Form as supported .doc(x) or .pdf files (Max 15MB).

Hold Harmless Agreement

No file chosen

Emergency Contact Form

No file chosen

Media Waiver

No file chosen

Preferences & AcknowledgmentsI am interested in being part of a DSOSN committee.I am interested in helping out at events.I am bilingual and am interested in assisting with translations.

If yes, please list which language(s) you would be willing to assist with:

By completing this Membership Application, you consent to Down Syndrome Organization of Southern Nevada including your name and details in their Membership List and email list for membership, administration and support purposes.

DSOSN

About Our Organization

Parent/Guardian Information