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7Pf8QkBUzoc6wKeFEWi3RLWBKcMAsE8d57AwmB7QQiSCa7AivciDu77mBU46sy2UiJKrhI4SCJ6XfxVGMIvxF2mKARQWHpt8xJrTq2

CEREBRAL PALSY FAMILY DAY | REGISTRATION FORM

SUNDAY, JUNE 7TH, 2026
4PM-8PM
MISSOURI BOTANICAL GARDEN IN ST. LOUIS
*The event will proceed rain or shine!
*Please be aware that there is limited capacity for this event. Families must arrive by 4:15pm. Late arrival may result in the forfeiture of your reserved spot if capacity is reached before then.

EVENT STRUCTURE

Programming for the day is split into two separate tracks.
Young adults with CP can attend either program.

Garden Programming	Resource Programming
Medically trained staff from the CP center at the St. Louis Children's Hospital--including physicians, physical and occupational therapists, and nurses--guide children with CP and their siblings through accessible activities in the garden.	Caregivers and young adults with CP connect with each other and with local resource partners to build community and plan for long-term goals.

INSTRUCTIONS:

Please provide information about all family members who will be attending.
Your RSVP is not complete until you address the corresponding media release forms on the second page.

Visit our website for more information.
If you have any questions, please email the event organizer, Emma Lott, at: cpfamilyday@wustl.edu

How many of your children have cerebral palsy?*

*Required field

* must provide value

reset

Please enter the following information about your child:
*Required field

First Name:*
Last Name:*
Date of Birth:*
Are they planning to attend CP Family Day?*

Calculated age:

View equation

Tell us more about ______.
*Required field

How do they get around?*
Do they have seizures?* (If yes, please describe their seizure plan.)
Please describe any medications they may need during the event. Include any rescue medications.* (Enter "N/A" if not applicable.)
Describe their toileting needs.* (e.g., are they independent or do they need assistance?)

Child 1 of 2

**Required* field

CHILD #1

First Name:*
Last Name:*
Date of Birth:*

Are they planning to attend CP Family Day?*

Child #1 calculated age:

View equation

Tell us more about ______.
*Required field

How do they get around?*
Do they have seizures?* (If yes, please describe their seizure plan.)
Please describe any medications they may need during the event. Include any rescue medications.* (Enter "N/A" if not applicable.)
Describe their toileting needs.* (e.g., are they independent or do they need assistance?)

Child 2 of 2

*Required field

CHILD #2

First Name:*
Last Name:*
Date of Birth:*

Are they planning to attend CP Family Day?*

Child #2 calculated age:

View equation

Tell us more about ______.
*Required field

How do they get around?
Do they have seizures? (If yes, please describe their seizure plan.)
Please describe any medications they may need during the event. Include any rescue medications.* (Enter "N/A" if not applicable.)
Describe their toileting needs. (e.g., are they independent or do they need assistance?)

Child 1 of 3

*Required field

CHILD #1

First Name:*
Last Name:*
Date of Birth:*

Are they planning to attend CP Family Day?*

Child #1 calculated age:

View equation

Tell us more about ______.
*Required field

How do they get around?
Do they have seizures? (If yes, please describe their seizure plan.)
Please describe any medications they may need during the event. Include any rescue medications.* (Enter "N/A" if not applicable.)
Describe their toileting needs. (e.g., are they independent or do they need assistance?)

Child 2 of 3

*Required field

CHILD #2

First Name:*
Last Name:*
Date of Birth:*

Are they planning to attend CP Family Day?*

Child #2 calculated age:

View equation

Tell us more about ______.
*Required field

How do they get around?
Do they have seizures? (If yes, please describe their seizure plan.)
Please describe any medications they may need during the event. Include any rescue medications.* (Enter "N/A" if not applicable.)
Describe their toileting needs. (e.g., are they independent or do they need assistance?)

Child 3 of 3

*Required field

CHILD #3

First Name:*
Last Name:*
Date of Birth:*

Are they planning to attend CP Family Day?*

Child #3 calculated age:

View equation

Tell us more about ______.
*Required field

How do they get around?
Do they have seizures? (If yes, please describe their seizure plan.)
Please describe any medications they may need during the event. Include any rescue medications.* (Enter "N/A" if not applicable.)
Describe their toileting needs. (e.g., are they independent or do they need assistance?)

How many additional children, who do not have cerebral palsy, will be attending?*

*Required field

* must provide value

reset

ADDITIONAL CHILD #1
Please enter the following information about this additional child: