EXTRAORDINARY KIDS with special hearts
1 in 100 babies are born with CHD. We want to celebrate you and hear your story!
Google에 로그인하여 진행상황을 저장하세요. 자세히 알아보기
이메일 *
Student's Name *
Student's Current School  *
Student's Current Grade *
Student's Birthday *
Student's Age *
Parent/Guardian Name *
Parent/Guardian Preferred Email *
Parent/Guardian Cell Phone (optional)
Please share your diagnosis & details *
If you haven't already, would you be open to a zoom call with your local AHA rep so we can talk about ways to share your story? *
Use this area to share more details (if needed)
We want to hear from you!
If you have already connected with your AHA rep but would like to give us an update on you, please send your pictures and videos to tammi.martin@heart.org
제출
양식 지우기
Google Forms를 통해 비밀번호를 제출하지 마세요.
이 설문지는 AHA Youth Market 내부에서 생성되었습니다. 악용사례 신고