CHEC :: Children's Health Environmental Coalition

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Tell Us Your Story

Statistics do not tell the human side of what an exposure to an environmental chemical can mean to a child. By sharing your child’s experience, you will help CHEC personalize and strengthen its message.

Name:
Please provide contact information. You may contact me via: (check all that apply)
mail:
	Address:
	City:
	Zip:
	State:
phone:
	Phone:
email:
	Email:

I am willing to share my story:		With parents On the CHEC website/CHEC print material

Yes No		I am willing to be contacted by others regarding my story (i.e. advocacy groups, media, etc.)

When writing, please include the following information: What is your child’s illness What has the impact of that illness been on him/her & family What do you suspect/know about environmental links to this illness What actions have you taken to address the problem How has CHEC helped you (providing resources, support, contacts)
Disease:
Exposure:		*suspected or confirmed
Tell us your story: