Place Postage Here Nick & Kelly Children’s Heart Fund 1321 Bayview Dr. Tempe, AZ 85283 ___________________________ ___________________________ ___________________________ Nick and Kelly Family Day at the Zoo “Caring for the CHD Family Wholeheartedly” Saturday, February 21st, 2015 at the Phoenix Zoo Sponsored by: Nick & Kelly Children’s Heart Fund Photo courtesy of the Phoenix Zoo 8:15 – 9:00 Registration/Networking 9:00 – 9:45 Opening Session Keynote Speaker Highlights of this year’s Heart Talk Sessions (teens attend opening session with parents) 9:45 – 10:00 BREAK Information and Networking (teens meet group leaders on the patio) 10:00 – 10:55 1st Breakout Session “Caring for the Conditions” (What’s New and What’s in Store for the Future”) *Options to choose from: 1) Single Ventricle 2) Rhythm Anomalies and Mild to Moderate Defects 3) Heart Failure and Pulmonary Hypertension 4) Heart Defects related to Genes, Chromosomes and Syndromes 11:05 – 12:00 2nd Breakout Session “Caring for the Family” (The Stress of Dealing with CHD in your Family) *Options to choose from: 1) Early Childhood (0-5) 2) School Age Children (5-11) 3) Pre-Teens and Adolescents (12-17) 4) Adults (18+) *teens may accompany parents to Breakout Sessions if interested 12:15 Lunch for all at the Lake REGISTRATION FORM Please indicate any special needs or concerns Notes: __________________________________________ Conference limited to immediate family due to space Parent/Guardian Name(s) attending conference: Parent MUST attend if children/teens attend _____________________________________________________ Address: _____________________________________________ City: _________________St. _________Zip: ________________ Phone: _______________Alternate phone number: ___________ E-Mail: _______________________________________________ Children/Teens will be in groups according to age & comfort level. List ALL children attending conference Patient Name: _________________________________________ Age: ____ Sex: F/M Shirt Size: Youth S/M/L Adult S/M/L/XL/XXL Sibling Name: _________________________________________ Age: ____ Sex: F/M Shirt Size: Youth S/M/L Adult S/M/L/XL/XXL Sibling Name: _________________________________________ Age: ____ Sex: F/M Shirt Size: Youth S/M/L Adult S/M/L/XL/XXL Sibling Name: _________________________________________ Age: ____ Sex: F/M Shirt Size: Youth S/M/L Adult S/M/L/XL/XXL  Please check this box acknowledging this policy - Child care for children under the age of 5 years will not be provided. Children of this age are welcome at the zoo, but must be supervised by a responsible adult at all times. We ask that you do not bring them in the lecture halls. Please find a care giver for your child while you attend the lectures. 10:55 – 11:05 BREAK Family Day Heart Talk Caring for the CHD Family Wholeheartedly Children under age 5 welcome to participate in Zoo events w/guardian. Adult sessions are not appropriate for children (can be disruptive). Use form to Register or Contact: Nick & Kelly Children’s Heart Fund Telephone: (480) 838-1529 Postal Address: 1321 E. Bayview Dr., Tempe, AZ 85283 E-mail: [email protected] Website: www.nickandkellyfund.org Must pre-register, limited space available, first come first served. Please sign waiver and include with registration form when mailing.