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Child's Name*

First

Tell your Kawasaki Disease story.

After this question we will have you summarize symptoms, age of diagnosis, day of diagnosis, etc. This can be as short or as long as you like, please just describe what you and your family went through.

Age Now

Age at Diagnosis

Day of Diagnosis

Symptoms*

Select all that apply.

Other symptoms

Misdiagnosis and treatment

Current Condition

Other Comments

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Your Information

Name

First Last

Relationship to child

Email

Address

(to only be used to send your Kawasaki Kid a little surprise)

Street Address Address Line 2 City State ZIP Code

*

Thank you for sharing your story and helping us raise awareness for Kawasaki Disease! By pressing submit you are giving Kawasaki Kids Foundation permission to use your story and any uploads on their website, social media, email, and additional marketing mediums. You also give permission for Kawasaki Kids Foundation to contact you if needed and to share their newsletter with you. Thank you again for making a difference.

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