Focus Families, Septo-optic dysplasia, Optic nerve hypoplasia

Conference Registration

Date: SATURDAY 26 JULY 2003

VENUE: BERKSHIRE COLLEGE OF AGRICULTURE,
HALL PLACE, BURCHETTS GREEN, MAIDENHEAD, BERKSHIRE


* Your Name:
* Your home address:
* Your contact 'phone number:
* Your email:
I will need child care. Yes No
If you need child care you will need to fill out the childcare portion of the form other wise scroll to the bottom of the page and hit send now. Please fill out a section for each child attending. Childcare will only be available for up to 2 children under 11 years old from each family.

Child 1
Name of Child Attending:
Age:

Please note that the childcare staff will not be able to administer medication. If you child is unwell on the day they will not be able to use the childcare.

Please tell us about your child's medical conditions:

Does your child suffer with any of the following :	Please Check all that apply Cortisol deficiency Epilepsy Diabetes Insipidus Asthma Severe allergic reaction None

Details :

If your child suffers with cortisol deficiency what are the symptoms of low sugar levels?

I do/do not want lunch provided for my child	Yes No

Please provide as much information as possible about your child, including their likes and dislikes, favourite games, etc, continuing overleaf if necessary. If you prefer you can let us have a copy of the information you provide for your child's nursery, regular carers or school. Please note that in the event of an emergency you will be called. We are not able to administer medication.



Child 2
Name of Child Attending:
Age:

Please note that the childcare staff will not be able to administer medication. If you child is unwell on the day they will not be able to use the childcare.

Please tell us about your child's medical conditions:

Does your child suffer with any of the following :	Please Check all that apply Cortisol deficiency Epilepsy Diabetes Insipidus Asthma Severe allergic reaction None

Details :

If your child suffers with cortisol deficiency what are the symptoms of low sugar levels?

I do/do not want lunch provided for my child	Yes No

Please provide as much information as possible about your child, including their likes and dislikes, favourite games, etc, continuing overleaf if necessary. If you prefer you can let us have a copy of the information you provide for your child's nursery, regular carers or school. Please note that in the event of an emergency you will be called. We are not able to administer medication.


A sandwich lunch and drinks will be provided for the children in the childcare. If you child has special dietary requirements you will have to provide for these. You will also have to provide nappies for your child. Please also remember to bring any special foods, cups etc and label them clearly. Please submit this slip, with the main registration form, by 30 June. We are unable to guarantee childcare facilities after this date.

Additional Comments:



Payment: Families - £10 per adult attendee Professionals - £30 per attendee

Cheques should be made payable to Focus UK by 30 JUNE AT THE LATEST. Please do not send cash. When completed this registration form, payment should be sent to: Jill Small 8 Quennells Hill Wrecclesham Farnham Surrey GU10 4ND

for more information write alison@focusfamilies.org



		This website has been designed to help empower parents of children with ONH/SOD. All the information herein is subject to opinion. If you suspect your child may have ONH/SOD it is recommended that you seek professional advice from a certified pediatric ophthalmologist. No one individual or company connected with this website assumes any liability or responsibility for it's contents. © copyright 2000 - 2006