supporting the families of children born unable to swallow

“

TOFS was such a support to us when we really didn’t understand what was going on, or who to ask, and we shall never forget that.

Kelly Saunders, parent?

”

Parents membership application

Please supply international dialling codes if you are overseas.

Fields marked with an asterisk (*) are required.

Child

First name & initials:*
Last name:*
Boy/girl:*
Date of birth:*

First Parent/Guardian

Title:*
First name & initials:*
Last name:*
Primary Contact Tel:
Alternative Contact Tel:
Mobile Tel:
Email:*
Occupation:

Second Parent/Guardian

Title:
First name & initials:
Last name:
Primary Contact Tel:
Alternative Contact Tel:
Mobile Tel:
Email:
Occupation:

Address for correspondence

Street address:*
Address 2:
Town:*
Postcode:*
Do you have a family website?:

All the above details will be treated in confidence and will not be passed on without your consent.

Are you willing to be contacted by other TOF families?:*
Can we use general information about your family in our TOFS newsletter?:*
Can we use photographs of your family provided by you or taken at TOFS events on our website and in our TOFS newsletter?:*

Child's details

The information in this section, whilst not mandatory, is very useful to us

Birthweight (in kg)
Was your child: Full term Premature Overdue
By how much?
At which hospital(s) did your child have surgery?:
Name of Surgeon(s):
Was your child born with:: Oesophageal Atresia Tracheo-Oesophageal Fistula Renal defects Skeletal defects VACTERL Imperforate Anus Heart defects

Please add information if you wish.

Please use this space to provide details of any other conditions with which your child was born:

Siblings

Please let us know of any brothers and sisters:
Twin?:

Please provide as many details as possible with regard to your child’s past and present condition, including type of surgery if known.
Have you any problems you would like help with?

Would you like to co-ordinate get-togethers in your area?
Would you like details of events in your area?
How did you hear about TOFS?

Please enter the word you see in the image below:

Membership

TOFS is entirely reliant on charitable donations to continue our activities. We therefore request all potential members make a monthly donation in lieu of a formal membership fee. By making a donation through the "Justgiving" website TOFS is able to recover the tax if you are a UK taxpayer.
Please make your donation now and enter the "Justgiving reference you receive in the box below.

Justgiving reference:*

I would like to become a member of TOFS.*

NOTE

If you are unable to make a donation at the present time or prefer not to do it on-line please complete the PDF Application form and submit it by post to the TOFS office.

Internal use: (to be completed by office)

Membership number
Information sent
CHEW

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