Kids Food Allergy Hangout

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Lurie Children's FASE (Food Allergy Support and Education) Program Events

Events are held throughout the year and cover various food allergy topics.

All meetings will be virtual unless otherwise indicated.

Name*

First Name*

Last Name*

Contact Phone Number*

Email*

Home Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Event Date*

Select your event date

How many children will be attending?

Name of 1st Child Attending

1st Child's Age

1st Child Gender

M F

Name of 2nd Child Attending

2nd Child's Age

2nd Child's Gender

M F

Name of 3rd Child Attending

3rd Child's Age

3rd Child's Gender

M F

Name of 4th Child Attending

4th Child's Age

4th Child's Gender

M F

Name of 5th Child Attending

5th Child's Age

5th Child's Gender

M F

Name of 6th Child Attending

6th Child's Age

6th Child's Gender

M F

Name of 7th Child Attending

7th Child's Age

7th Child's Gender

M F

Name of 8th Child Attending

8th Child's Age

8th Child's Gender

M F

Name of 9th Child Attending

9th Child's Age

9th Child's Gender

M F

Name of 10th Child Attending

10th Child's Age

10th Child's Gender

M F

Is your child a patient of Lurie Children's Division of Allergy & Immunology?*

Yes No

If not, who is your child's allergist?*

How did you hear about the class?*

Flyer/brochure in clinic Lurie Children's website Allergy & Immunology Facebook page Allergist Mom Facebook page

Other: Other Value

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