Family Survey & Free Attendee Registration

Photography, Videography and Promotional Consent*

I agree that I and my family members including children under 18 who are participating in said C.A.S.E. event are willing to be photographed, filmed, or otherwise recorded by C.A.S.E.

I DO NOT agree that I and my family members including children under 18 who are participating in said C.A.S.E. event are willing to be photographed, filmed, or otherwise recorded by C.A.S.E.

Please check the box to give your consent. Photography and videography of KAN will be used to help C.A.S.E. promote future events.

Have you, your child(ren)/teen ever attended previous KAN Conferences? How many?*

This field is required.

From your perspective, has your child(ren)/teen experienced any difficulties related to adoption?*

This field is required.

How often does your family talk about adoption? What types of questions does your child(ren)/teen bring up about adoption?*

This field is required.

Do you have a transracial or transcultural adoptive family?*

Transracial

Transcultural

Both

None

Please check all that apply.

Parent Name (one parent must register to attend)*

This field is required.

First & Last Name of Parent

2nd Parent Name

This field is required.

First & Last Name of Parent

Child 1 - First and Last Name*

This field is required.

First and Last Name

Child 1 - Type of Adoption*

Domestic

International

Private

Foster Care (Kinship)

Foster Care (Teen)

Foster Care (Child)

Please select the type of adoption.

Child 1 - Age at Placement*

This field is required.

If you are a parent attending without a child, please type N/A.

Child 1 - Grade Level*

This field is required.

Child 1 - Ethnicity*

This field is required.

Child 2 - First and Last Name

This field is required.

First and Last Name

Child 2 - Type of Adoption

Domestic

International

Private

Foster Care (Kinship)

Foster Care (Teen)

Foster Care (Child)

Please select the type of adoption.

Child 2 - Age at Placement

This field is required.

If you are a parent attending without a child, please type N/A.

Child 2 - Grade Level

This field is required.

Child 2 - Ethnicity

This field is required.

Child 3 - First and Last Name

This field is required.

First and Last Name

Child 3 - Type of Adoption

Domestic

International

Private

Foster Care (Kinship)

Foster Care (Teen)

Foster Care (Child)

Please select the type of adoption.

Child 3 - Age at Placement

This field is required.

If you are a parent attending without a child, please type N/A.

Child 3 - Grade Level

This field is required.

Child 3 - Ethnicity

This field is required.

Child 4 - First and Last Name

This field is required.

First and Last Name

Child 4 - Type of Adoption

Domestic

International

Private

Foster Care (Kinship)

Foster Care (Teen)

Foster Care (Child)

Please select the type of adoption.

Child 4 - Age at Placement

This field is required.

If you are a parent attending without a child, please type N/A.

Child 4 - Grade Level

This field is required.

Child 4 - Ethnicity

This field is required.

Does your child take any medication?*

This field is required.

If yes, please list. (If your child normally takes medication during the school day please have them take these medications for KAN.)

Does your child have any allergies or health issues we should be aware of? Please explain.*

This field is required.

For staffing purposes, has your child required additional supports in the classroom? Please explain.*

This field is required.

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Family Survey & Free Attendee Registration

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