702-648-1990

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MEMBER REGISTRATION

Please complete and submit the membership form and waivers below.

If you have more than one child or family member with Down syndrome, please complete separate applications for them. For any non-applicable sections, please put N/A.

If you would like to complete and submit a physical application and forms, please download the application here. Completed application and forms can be mailed to the DSOSN office at 5300 Vegas Dr. Las Vegas, NV 89108 or can be emailed to us at dsosn@dsosn.org.

Application Type

New Membership

Membership Renewal

Changes for Directory

Application Date

Parent/Guardian Information

Parent 1

First Name

Are you of Hispanic or Latino descent? (Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture)

Yes

Last Name

Home Phone

Cell Phone

Language(s) you speak

Parent 2

First Name

Are you of Hispanic or Latino descent? (Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture)

Yes

Last Name

Home Phone

Cell Phone

Language(s) you speak

Mailing Address

Address

City

State

Zip Code

Individual with Down syndrome's Information

First Name of Individual with Down syndrome

Last Name of Individual with Down syndrome

Date of Birth of Individual w/ Down syndrome

Are they of Hispanic or Latino descent?

Yes

Language(s) they speak

Age

Relationship to Applicant

Additional Family Member(s) Information

First & Last Name of Family Member

Age

First & Last Name of Family Member

Age

First & Last Name of Family Member

Age

First & Last Name of Family Member

Age

Forms & Waivers

Please download, complete, and upload the following forms and waivers before submitting your membership application. If you have trouble uploading them, you can email them to us at dsosn@dsosn.org.

Emergency Contact Form

Hold Harmless Agreement

Media Waiver

Please upload each form separately in the format:

Last Name, First Name_Name of Form

as supported .doc(x) or .pdf files (Max 15MB).

Emergency Contact Form

Upload File

Upload supported file (Max 15MB)

Hold Harmless Agreement

Upload File

Upload supported file (Max 15MB)

Media Waiver

Upload File

Upload supported file (Max 15MB)

Preferences & Acknowledgments

I am interested in being part of a DSOSN committee.

I am interested in helping out at events.

I am bilingual and am interested in assisting with translations.

If yes, please list which language(s) you would be willing to assist with:

I authorize the verification that the information provided on this form is correct.

By completing this Membership Application, you consent to Down Syndrome Organization of Southern Nevada including your name and details in their Membership List and email list for membership, administration and support purposes.

Thank you for submitting your membership application! As a member, you will receive emails regarding our programs, services and events. Please let us know if you have any questions at (702) 648-1990 or dsosn@dsosn.org.

Down Syndrome Organization of Southern Nevada (DSOSN) is a 501(c)(3) nonprofit organization serving individuals and families in Southern Nevada affected by Trisomy-21, more commonly known as Down syndrome. Nonprofit Federal Tax ID: 94-3040560.

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dsosn@dsosn.org

5300 Vegas Drive Las Vegas, NV 89108

702-648-1990

Monday - Friday: 9 a.m. - 2 p.m.

702-648-2020

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