2012 Shreveport JA Family Day, Saturday, October 27th, 10:00am to 1:00pm

For families impacted by Juvenile Arthritis (JA) and Rheumatic Diseases.
Kids with JA and Siblings: Fun activities and connecting with other kids!
Parents: Q&A session with physicians and physical therapists, meeting other parents and learning the latest information to be your child's best advocate.
Lunch is provided.
PLEASE NOTE: Up to four Sci-Port tickets provided per family. Additional tickets may be purchased here for $6 per person.
Registration Deadline: October 15th
Register here or complete hard copy registration form from physican's office.
Questions? Please contact Emily Pearce at epearce@arthritis.org or (501) 708-2917.

Location:    Sci-Port
     820 Clyde Fant Parkway
     Shreveport, LA  71101

Name Location Start Date Start Time End Date End Time
Parent Session  Sci-Port Solarium Area   10/27/2012  12:00 AM  10/27/2012  12:00 AM
Supervised Children's Activities  Sci-Port Center   10/27/2012  10:00 AM  10/27/2012  12:00 PM
Lunch (Boxed Lunch Provided)  Sci-Port Center   10/27/2012  12:00 PM  10/27/2012  01:00 PM
Family Free Time  Sci-Port Center   10/27/2012  01:00 PM  10/27/2012  06:00 PM
* required information
Registration Information
First Name:*
Last Name:*
Relationship to Child with Arthritis:
Additional Adult's Name:
Name of Child with Arthritis:*
Age of Child with Arthritis:*
Type of Arthritis or Rheumatic Disease:
Date of Diagnosis:(mm/dd/yyyy)
Physician's Name:
Names and Ages of Additional Children:*
Relationship to Child with Arthritis:
Address Line 1:*
Address Line 2:
ZIP/Postal Code:*
For Boxed Lunch: Please list any food allergies for family members attending:
How Did You Hear About JA Family Day?:
Registration up to Four Family Members:
Up to four tickets provided per family. Please enter the number of tickets up to four.
(No Charge)
Tickets Exceeding Four Family Members:
Please enter the number of additional tickets you need to purchase.
@ $6.00 = $

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