NICU Reunion Registration Form

Every child who was ever admitted to any Akron Children's neonatal intensive care unit (NICU) and/or special care nursery (SCN) throughout northeast Ohio (and their family members/guardians) is invited to attend this FREE event. Please complete the following fields and click DONE.

Parent/Guardian Information

How many people are attending (including yourself) :

Parent Last Name :

Parent First Name :

Mailing Address :

City :

State :

Zipcode :

Phone :

Email :

Name(s) of NICU staff member(s) you hope to see at the reunion:

Comments/Questions :


NICU Grad Information

Please fill out, as completely as possible, the information for each graduate you would like to attend:

Graduate 1:

Admission Name :

Current Name (if different) :

Admission Year :

Location of initial admission :

Graduate 2:

Admission Name :

Current Name (if different) :

Admission Year :

Location of initial admission :

Graduate 3:

Admission Name :

Current Name (if different) :

Admission Year :

Location of initial admission :

Graduate 4:

Admission Name :

Current Name (if different) :

Admission Year :

Location of initial admission :

Graduate 5:

Admission Name :

Current Name (if different) :

Admission Year :

Location of initial admission :

Graduate 6:

Admission Name :

Current Name (if different):

Grad #6 Admission Year :

Location of initial admission :


If you would like to have pictures of your child posted on a display board at the event, please name the images appropriately (with Grad's name) and email them to kstefan@chmca.org (20 mb or less total) or send to NICU Reunion, c/o Kristie Stefan, March of Dimes Coordinator, Akron Children's Hospital, One Perkins Square, Akron, OH 44308



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