Sibling VIP Kit - Order Form

KCNT1 siblings have a different childhood experience compared to their peers, and we recognize that they need support as well. They may be anxious about what their sibling is going through, have a hard time adapting to their changing routines, and they may feel neglected because their parent’s time is limited while caring for their KCNT1 warrior.

What can we do about it?

We are offering new resources to support siblings and their families: Caregiver & Sibling VIP Kits!

Thanks to UCB, we are able to provide these resources absolutely free to families in our community. Read below about this resource and how these kits can be a valuable resource for KCNT1 siblings and caregivers. Follow the links to complete the order form & receive your kit!

Email *
Parent or Guardian name *
I am the primary caregiver and have signed for the KCNT1 Family Contact list.

(Only registered members of the KCNT1 Family Contact list who reside in the U.S. may register to receive a VIP Sibling Kit. If you are not a member you will be contacted about how to become one.) https://kcnt1epilepsy.org/kcnt1-family-contact-form-1 

 *
You can order three different types of kits:  One for parents and caregivers, and there are two options for kids, depending on their age.

Please let us know if you would like to request a Parent & Caregiver resource kit. 

Clear selection
Please select which Sibling kits you would like. You can share their names in the following question.
Kit: Ages 4-10
Kit: Ages 11-18
Sibling 1
Sibling 2
Sibling 3
Sibling 4
Sibling 5
Sibling 6
Sibling 1:  First and Last name
Sibling 2:  First and Last name
Sibling 3: First and Last name
Sibling 4:  First and Last name
Sibling 5:  First and Last name
Sibling 6:  First and Last name
Please provide complete mailing address where kit(s) should be sent. (Currently we only ship to U.S. addresses.):
 *
Phone number:
Please provide your preferred contact method if we need to contact you with any questions.
Would any of your children like to be included in the Sibling Circle quarterly Zoom calls? 
Clear selection
Special Notes or Comments:
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