Children’s Heart Week 2010 will run from Saturday 8th – Sunday 16th May. During the week, the charities that belong to the Children’s Heart Federation will be trying to raise awareness of congenital and acquired heart disease. To do this, we need a wide range of case stories to feature in newspapers, magazines, radio and television.
If you are willing to contribute your own story please complete the form below. You can also download a paper version of the form and mail it back to us using our usual contact information.
Your Details
Please supply your contact details. Fields marked with an asterisk (*) are mandatory.
Name*
Address*
Town/City*
County*
Postcode*
Country*
Telephone Number
Email Address
Confirm Email Address
Who's Who?
Identify the main members of your family using the fields below.
Your Story
Please tell us your story. None of the fields below are compulsory so you may complete as much or as little as you wish.
When was your child diagnosed? (M/YYYY)
Your child's treatment history (What, When, Where and by Whom?)
How does having a heart condition affect your child's life today?
How does your child's conditon affect the whole family?
Please tell us about a time that was really positive for your child / family in relation to your child's heart condition.
Please tell us about a time that was really tough for your child / family in relation to your child's heart condition.
Please tell us about some of your family's hopes, dreams and ambitions in relation to your life with a heart child.
Please tick all of the media outlets where you are willing to share your experiences.
You can upload a photograph to be used in conjunction with your story by using the form below.
Thank you for taking the time to complete this form.
