2015 Shreveport JA Family Day - Saturday, October 10, 2015
10:00am to 1:00pm




Join us to meet other families impacted by Juvenile Arthritis (JA) and Rheumatic Diseases.

JA Kids and their Siblings will have the opportunity to meet other kids and join in fun activities!

Parents will have a Q&A session with physicians and physical therapists; meeting other parents; and learning the latest information to be your child's best advocate.

*PLEASE NOTE: Registration is limited to parents or legal guardian, children with JA, and siblings 18 years of age and under (maximum 6 registrations per family). Lunch will be provided. Check In begins at 9:30 a.m.


Registration Deadline: October 2, 2015.

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:    ArtSpace
     710 Texas Street
     Shreveport, LA  71101

Name Location Start Date Start Time End Date End Time
Check In     10/10/2015  09:30 AM  10/10/2015  10:00 AM
Parent Session     10/10/2015  10:00 AM  10/10/2015  12:00 PM
Supervised Children's Activities     10/10/2015  10:00 AM  10/10/2015  12:00 PM
Lunch (Lunch Provided)     10/10/2015  12:00 PM  10/10/2015  01:00 PM
* required information
Registration 

Registration Information
First Name:*
Last Name:*
Relationship to Child with Arthritis:*
Additional Adult's First & Last Name:
First and last name of Child with Arthritis:*
What type of arthritis affects you the most?:*
Gender:* Female   Male  
Age: years old
Date of Diagnosis:(mm/dd/yyyy)
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Email:*
Phone:*
Physician's Name:
How Did You Hear About JA Family Day?:*
Please enter the number of attendees:
  How many will be attending?
 
Quantity:* 
Total Cost: $

Please enter details for additional attendees below:
JA Child Food Alergies:
JA Child T-Shirt Size:*
Parent Food Allergies:
Additional Parent/Adult Food Allergies:
Sibling #1 First & Last Name:
Sibling #1 Age:
Sibling #1 Gender: Male
Female
Sibling #1 Food Allergies:
Sibling #1 T-Shirt Size:
Sibling #2 First & Last Name:
Sibling #2 Age:
Sibling #2 Gender: Male
Female
Sibling #2 Food Allergies:
Sibling #2 T-Shirt Size:
Sibling #3 First & Last Name:
Sibling #3 Age:
Sibling #3 Gender: Male
Female
Sibling #3 Food Allergies:
Sibling #3 T-Shirt Size:
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