Allergy Pals and Allies – Registration winter 2024

Child's name *

First

Last

Child's age *

Child's gender

Female
Male
Other gender
Prefer not to say

Child's food allergy (check all that apply) *

Parent's name *

First

Last

Parent's email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

The program starts the weekend of January 28, 2024 with 6 groups. Please sign your child up for one group (day/time) you can attend for the duration of the program (8 weeks). *

Group 1 – Allergy Pals Beginner: Sunday: 11:00am – 12:00pm EST
Group 2 – Allergy Pals Connect: Sunday: 7:00pm – 8:00pm EST
Group 3 – Allergy Allies: Monday: 6:30pm – 7:30pm EST
Group 4 – Allergy Pals Connect: Tuesday: 7:00pm – 8:00pm EST
Group 5 – Allergy Pals Beginner: Wednesday: 7:30pm – 8:30pm EST
Group 6 – Allergy Pals Connect: Thursday: 7:00pm – 8:00pm EST

Please check boxes below to agree to the terms of the program: *

I grant permission for my son/daughter to attend all sessions over the eight week program.
I grant permission for my son/daughter to use their webcam with the group.
I agree to not store copyrighted program materials and/or publish them.

Allergy Pals and Allies – Registration winter 2024

Please complete and submit the form below to register your child for our winter Allergy Pals/Allies sessions.