Circle of Food Allergic Families, COFAF
MEMBERSHIP
APPLICATION
Interested in joining COFAF... We serve the greater Metropolitan Detroit Area.  We've been in existence since June, 2004. 

Please complete the form below and click on the submit button when you are done.
Name:
Address:
Zip Code:
City:
E-Mail:
Home
Phone:
DOB:
Child #1:
Site Directory
Allergies: Milk Peanuts Soy Fish Corn
Eggs Tree Nuts Wheat Shellfish Latex
Other:
Child #2: DOB:
Allergies: Milk Peanuts Soy Fish Corn
Eggs Tree Nuts Wheat Shellfish Latex
Other:
Child #3: DOB:
Allergies: Milk Peanuts Soy Corn
Fish
Eggs Tree Nuts Wheat Latex
Shellfish
Other:
How did you
hear about us?:		 Physician/Pediatrician Internet
Allergist Newspaper
Friend Magazine
Other:
Asthma
Other Health
Concerns?:		 Environmental Allergies
Eczema Eosinophilic Disorders
Other:
What subjects would you most like to see on our website or in our newsletter?: Advocacy
Recipes & Cooking Tips
Food Products
Research
Other People's Stories
Restaurants & Dining Out
Practical Tips
Schools & Child Care
Other:
Do you have a Practical Tip to Share?:
If you are interested in our Member to Member Mentoring Program, please complete the following questions.
Please rate yourself as to your knowledge level of managing food allergies:
Beginner - I know very little and am struggling to manage
Intermediate  - I know some about food allergies.  I'm avoiding ingredients but have little confidence in my abilities to manage.
Knowledgeable - I know a lot about food allergies.  I am comfortable managing them and feel I do a good job of avoiding reactions.
Very Knowledgeable - I am very comfortable managing food allergies.  I think I have learned a lot from doing research.  I know a lot of hidden places for the allergens we avoid.
Extremely Knowledgeable - I call manufacturers and ask about cross-contamination risks.  I experiment in the kitchen with new recipes.  I do lots of research and love to talk to others about managing food allergies.
Please rate yourself on how well you manage the following, a score of 1 being poorly and 5 being expert:
  1         2         3         4         5
Eating away from home
Other activies outside the home (such as visiting the homes of other's who do not have food allergies)
Child care and schools
Involvement of immediate family in managing food allergies
Lack of awareness from other people
Cooking and food preparation
Nutrition and diet
Purchasing packaged foods
Fear of a Reaction
Responding to a Reaction
Stress associated with managing food allergies
What other areas do you find difficult in managing your child(ren)'s food allergies?
How do you prefer we contact you about this program?
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