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Special Notice

The Everyday Wisdom Kit is intended only for parents and caretakers of children with type 1 diabetes. While the kits are free, there is a limited supply. Please only order the kit for your child with type 1 diabetes. Thank you.

Order your Everyday Wisdom™ Kit

 

1.
Question - Not Required - Yes! Send an Everyday Wisdom Kit for families of kids recently diagnosed with diabetes. (Please limit to one kit per household)

2.
Question - Not Required - YES! Send information about the American Diabetes Association's research, education, advocacy and local programs.

3.
Question - Not Required - YES! Send us the free Family Link E-newsletter, Homefront Magazine and trial issue of Diabetes Forecast.

4. Please enter parent's name and address information: (NOTE: At this time we are unable to accept PO Boxes or addresses outside the US.)

 

Name:

 

 

   

*

 

 

 

City/State/ZIP:

 

    

 

 


5.  


6.
Question - Not Required - Child's Gender:


7.
Question - Not Required - Child's Birthdate:




8.
Question - Not Required - Child's Date of Diagnosis:




9.
Question - Not Required - How did you hear about this program? Please pick one.
Please make up to 1 selection from the choices below.

10.  


 

The American Diabetes Association welcomes your feedback, questions or suggestions any time. Please e-mail AskADA@diabetes.org or call 1-800-DIABETES (1-800-342-2383).

11.


   Please leave this field empty