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oBI4H7hwJ25vxx5bX3QVuysMrsTNUMw5YDG3x3w9rqxQX6yZJ

Caregiver Workshop Registration Form

Dear Caregiver,

Thank you for your interest in the Transition Planning for Caregivers Workshops!

Two separate workshop are being offered. The first is for caregivers of adolescents with intellectual disability who will require guardianship when they turn 18.

This event will be held on Friday, April 5th from 10:00am-12:00pm via Zoom webinar.

Featuring:

Overview of transition basics
Guardianship process
Professional panel
Patient/Family Experience

The second workshop is for caregivers of adolescents with chronic illness and/or complex healthcare needs who will require assistance navigating college and/or the workforce.

Featuring:

Overview of transition basics
Navigating college with a chronic medical condition
Job searching & workplace accommodations
Considerations for transfer to adult medical care
Professional panel
Patient/Family Experience

We are in the process of planning this workshop and the site will be updated once we have confirmed the date.

If you have any questions, please email SWTransition@childrens.harvard.edu

Thank you!

First Name

* must provide value

Last Name

* must provide value

Address

* must provide value

City

* must provide value

State

* must provide value

Zip

* must provide value

Preferred method of contact

Phone E-mail

Is it okay to leave a voicemail message?

Yes No

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Phone Number

* must provide value

Will another caregiver be logging into the workshop?

Yes

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First Name

Last Name

Relationship to the child

First Name

* must provide value

Last Name

* must provide value

MRN (if known)

DOB

* must provide value

M-D-Y

Please list the conditions that bring your child to Boston Children's Hospital (BCH)

* must provide value

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Please let us know the BCH clinics and/or departments in which your child is seen

* must provide value

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Please select which workshop this registration form is for

* must provide value

Intellectual Disability (ID) on Friday, April 5th, 2024

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Intellectual Disability Flyer

Attachment:

Transition Flyer - ID (4.24).pdf

Adolescents & Young Adults with Chronic Illness Flyer

Attachment:

Chronic Illness Caregiver Training Flyer March 2024 NO DATE.pdf

Please let us know how you heard about the workshop

* must provide value

Hospital Facebook page

Posted flyer

Social Worker

Medical team member

Mailing

Other

Person(s) name

Please specify

What do you hope to gain from this training?

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We invite you to submit a question that will be considered for our professional panel to discuss

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.