International FOXG1 Foundation

Use this form to register an account with the FoxG1 website.
After the registration you will be able to enter and manage information about your child, and access protected areas of the website.

Your name

Your Email (to be used when logging into the website)

I agree to this data to be shared within the Local Parent FOXG1 entities and with the International FOXG1 Foundation who will use this for internal purposes only. I may be asked to update this information on a yearly basis. Newsletters and email alerts may be sent to me occasionally so I'm informed of key information. Should the FOXG1 parent entities wish to share my information outside of the FOXG1 parent groups, they will systematically ask for my authorization.

Mother of the FOXG1 child

Mother's Name

Mother Email

Mother's Phones

Mother Facebook Name

Mother Language Spoken

Father of the FOXG1 child

Father's Name

Father Email

Father's Phones

Father Facebook Name

Father Language Spoken

Caregiver of the FOXG1 child

Caregiver's Name

Caregiver Email

Caregiver's Phones

Caregiver Facebook Name

Caregiver Language Spoken

New User Registration

Mother of the FOXG1 child

Father of the FOXG1 child

Caregiver of the FOXG1 child