Please fill in this form to register for the next Childhood Stroke Parent Support and Information Day on Saturday 10 June 2017. 

* Denotes a required field

Please list names of all attendees. The day is for parents and carers, and not for children or young people
Please provide an email address for everyone attending (if possible)
If you don't have an email address or would prefer to be contacted by another method, please detail above.
We'd like to try and enable families from the same area to find one another on the day – so it's helpful to have some idea where you're travelling from.
Lunch will be provided on the day so please tell us if you have any allergies or special requirements.
Please let us know if there's anything we can do to make your day more enjoyable or comfortable.