Become a Rescue Angel


If you have a child that has improved or recovered from Autism through biomedical treatment and you want to help other families, please fill out the form below. Be as complete as possible.

Contact Information
Your Name
City
State
Zip Code
Country
Your Email Address *
Select a Password (for future use)
Phone (will not be shared without your permission)		Area Code - Phone Number -
About your Affected Child
Year your child was born
Major Symptoms
Therapies most helpful
How well would you say medical interventions helped your child?
Additional Information
Why do you want to become a Rescue Angel?
Are you willing to take calls from other parents?		Yes No
Are you interested in helping regionally coordinate Rescue Angels for meetings and such?		Yes No
Would you be willing to host a local fundraising event?		Yes No
Would you be willing to volunteer to support a fundraising event?		Yes No
Do you have a business or service/talent that might be able to help support Generation Rescue?		Yes No
Do you work at a company that might be interested in a "matched giving" campaign or a donation of services to help?		Yes No
Would you be willing to help qualify local autism services for Generation Rescue's service provider database?		Yes No
In what areas of autism and related disorders do feel most knowledgeable? Basically, what are your strengths?
Do you have some other ideas of how you would like to help Generation Rescue?

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