Volunteer Form

Regional Lead Parent

Regional Lead Parents (RLPs) are the local face of Jack’s Basket in regions across the United States. RLPs are critical to our mission of celebrating every baby diagnosed with Down syndrome as they create personal relationships with medical providers around the country and coordinate parent-delivered baskets reaching new families in their local area. The approximate time commitment expected of an RLP is an average of 4-6 hours per month, depending on region.

Qualifications

• Must be a parent of a child with Down syndrome between the ages of 6 months and 10 years

• Aligned with the mission of Jack’s Basket

• Prepared to share their own diagnosis story and experience as a parent of a child with Down syndrome

• Well-organized with strong time management and communication skills

• Empathetic and able to communicate with families from diverse backgrounds and experiences, meeting them “where they are” on their new journey as parents

• Willing to drive distances of up to 30 miles (or 45 minutes)

• Commitment to Jack’s Basket Statement of Support and Confidentiality

Key Responsibilities

• Establish and maintain contacts at local hospitals or clinics to encourage requests for baskets and communication about the program to staff

• Facilitate meetings at the hospitals and clinics in their area. Replenishing materials for medical providers

• Host an annual fundraising effort, such as a pancake breakfast or online fundraiser tied to a local 5K, to create awareness and raise money to support baskets

• Assign local basket delivery parents (BDP) for basket delivery or call/text connections within 6 hours of being alerted by HQ

• Ensure delivery of basket or call/text connection and follow-up is done. Delivering a basket periodically to stay current and engaged with new families or when a BDP is not available. You may be the BDP in your area!

• Periodically check in with BDPs to debrief on experiences, confirm the number of baskets on hand, and share updated information

• Attend meetings with HQ and other RLPs for updates and a chance to share your successes!

Regional Lead Parent Application Form

Applications are OPEN! We will begin interviewing in February 2024.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

What language(s) do you speak?(Required)

What's your occupation?(Required)

What are three words that describe you?(Required)

Who, if anyone, referred you to be a Jack's Basket Parent volunteer?

Your child's name(Required)

First Last

Your child's birthdate(Required)

Has your child had a heart surgery?

Yes

Was the diagnosis given at birth or prenatally?(Required)

Birth diagnosis

Prenatal diagnosis

What was your experience when your child was diagnosed with Down syndrome? Share your story:(Required)

What other details of your child's diagnosis would help you relate to other parents?

Additional health concerns, stay in the NICU, etc.

Why do you want to be a Regional Lead Parent for Jack's Basket?(Required)

What skills or experience do you have that you feel would be useful in communicating with medical professionals regarding the Down syndrome diagnosis and Jack's Basket programming?(Required)

Did you receive a Jack's Basket?(Required)

Yes

Please provide the names and emails of at least two personal or professional references. Our team will be in contact them during your application process.

Reference #1(Required)

First Last

Relationship

Reference #2(Required)

First Last

Relationship

Reference #3(Required)

First Last

Relationship