CdLS USA Foundation: Connect With Another Family

Cornelia de Lange Syndrome Foundation, Inc.
302 West Main St. #100
Avon, CT USA 06001
Phone: 860-676-8166
Phone: 800-223-8355
Fax: 860-676-8337
email: info@cdlsusa.org

For Parents Only: Connect With Another Family

We can help you connect with another family in your area.
Simply fill out the form on this page and click Submit.
Fields marked with an asterisk (*) are required.

TELL US ABOUT YOU

Name *
Street Address *
City *
State/Province *
Postal Code *
Country *
	(If you reside outside the United States and there is a National Association in your country, we will forward your information to them.)
Telephone *
E-mail *

Have you contacted the CdLS-USA Foundation before? * Yes No

TELL US ABOUT THE PERSON WITH CdLS IN YOUR LIFE

Name *
Age *
Date of Birth *	, (Leave defaults if unknown)
Your Relationship to this Person *

Has a diagnosis of CdLS been confirmed? Yes No

RELEASE INFORMATION

* To allow us to match you with another family, we need your permission to do so by checking the box at left.

ADDITIONAL COMMENTS (500 character maximum):

Please let us know more about your family and your wish to be matched. Do you wish to be matched with a family who has a child similar to yours, a family in your state, a person who may share the same concern? If you have anything else to share that will help us meet your need, please let us know that as well. Thank you.