CdLS Online Family Album

* - Required Fields

NEW LISTING OR UPDATE?:

New Listing
Update to my current listing

* Person completing form:

* Email:

Relationship to person with CdLS:

State:

First name or nickname only:

Date of Birth (mm/dd/year): Date of Death if applicable (mm/dd/year):

Birthweight: Weight now: Height now:

Limb differences? No Yes

Brothers/Sisters and birth years:

Living Arrangements:
At Home
Residential Facility
Independent
Group Home
Other, please explain:

Favorite things (25 words or less):

Favorite activities (25 words or less):

Share and Learn: What would you like to share with/learn from others? (50 words or less)

* Yes, I wish to be included in the CdLS Online Family Album and I give permission to the Cornelia de Lange Syndrome Foundation (CdLSF) to publish this information and any photos supplied by me on the CdLS website www.cdlsusa.org

For information on including a picture with your profile submission, please complete above information and click “Submit Form” below.