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Copiah County
Covington County
DeSoto County
Forrest County
Franklin County
George County
Greene County
Grenada County
Hancock County
Harrison County
Hinds County
Holmes County
Humphreys County
Issaquena County
Itawamba County
Jackson County
Jasper County
Jefferson County
Jefferson Davis County
Jones County
Kemper County
Lafayette County
Lamar County
Lauderdale County
Lawrence County
Leake County
Lee County
Leflore County
Lincoln County
Lowndes County
Madison County
Marion County
Marshall County
Monroe County
Montgomery County
Neshoba County
Newton County
Noxubee County
Oktibbeha County
Panola County
Pearl River County
Perry County
Pike County
Pontotoc County
Prentiss County
Quitman County
Rankin County
Scott County
Sharkey County
Simpson County
Smith County
Stone County
Sunflower County
Tallahatchie County
Tate County
Tippah County
Tishomingo County
Tunica County
Union County
Walthall County
Warren County
Washington County
Wayne County
Webster County
Wilkinson County
Winston County
Yalobusha County
Yazoo County
Missouri County
*
Adair County
Andrew County
Atchison County
Audrain County
Barry County
Barton County
Bates County
Benton County
Bollinger County
Boone County
Buchanan County
Butler County
Caldwell County
Callaway County
Camden County
Cape Girardeau County
Carroll County
Carter County
Cass County
Cedar County
Chariton County
Christian County
Clark County
Clay County
Clinton County
Cole County
Cooper County
Crawford County
Dade County
Dallas County
Daviess County
DeKalb County
Dent County
Douglas County
Dunklin County
Franklin County
Gasconade County
Gentry County
Greene County
Grundy County
Harrison County
Henry County
Hickory County
Holt County
Howard County
Howell County
Iron County
Jackson County
Jasper County
Jefferson County
Johnson County
Knox County
Laclede County
Lafayette County
Lawrence County
Lewis County
Lincoln County
Linn County
Livingston County
McDonald County
Macon County
Madison County
Maries County
Marion County
Mercer County
Miller County
Mississippi County
Moniteau County
Monroe County
Montgomery County
Morgan County
New Madrid County
Newton County
Nodaway County
Oregon County
Osage County
Ozark County
Pemiscot County
Perry County
Pettis County
Phelps County
Pike County
Platte County
Polk County
Pulaski County
Putnam County
Ralls County
Randolph County
Ray County
Reynolds County
Ripley County
St. Charles County
St. Clair County
Ste. Genevieve County
St. Francois County
St. Louis County
Saline County
Schuyler County
Scotland County
Scott County
Shannon County
Shelby County
Stoddard County
Stone County
Sullivan County
Taney County
Texas County
Vernon County
Warren County
Washington County
Wayne County
Webster County
Worth County
Wright County
St. Louis City
Montana County
*
Beaverhead County
Big Horn County
Blaine County
Broadwater County
Carbon County
Carter County
Cascade County
Chouteau County
Custer County
Daniels County
Dawson County
Deer Lodge County
Fallon County
Fergus County
Flathead County
Gallatin County
Garfield County
Glacier County
Golden Valley County
Granite County
Hill County
Jefferson County
Judith Basin County
Lake County
Lewis and Clark County
Liberty County
Lincoln County
McCone County
Madison County
Meagher County
Mineral County
Missoula County
Musselshell County
Park County
Petroleum County
Phillips County
Pondera County
Powder River County
Powell County
Prairie County
Ravalli County
Richland County
Roosevelt County
Rosebud County
Sanders County
Sheridan County
Silver Bow County
Stillwater County
Sweet Grass County
Teton County
Toole County
Treasure County
Valley County
Wheatland County
Wibaux County
Yellowstone County
Nebraska County
*
Adams County
Antelope County
Arthur County
Banner County
Blaine County
Boone County
Box Butte County
Boyd County
Brown County
Buffalo County
Burt County
Butler County
Cass County
Cedar County
Chase County
Cherry County
Cheyenne County
Clay County
Colfax County
Cuming County
Custer County
Dakota County
Dawes County
Dawson County
Deuel County
Dixon County
Dodge County
Douglas County
Dundy County
Fillmore County
Franklin County
Frontier County
Furnas County
Gage County
Garden County
Garfield County
Gosper County
Grant County
Greeley County
Hall County
Hamilton County
Harlan County
Hayes County
Hitchcock County
Holt County
Hooker County
Howard County
Jefferson County
Johnson County
Kearney County
Keith County
Keya Paha County
Kimball County
Knox County
Lancaster County
Lincoln County
Logan County
Loup County
McPherson County
Madison County
Merrick County
Morrill County
Nance County
Nemaha County
Nuckolls County
Otoe County
Pawnee County
Perkins County
Phelps County
Pierce County
Platte County
Polk County
Red Willow County
Richardson County
Rock County
Saline County
Sarpy County
Saunders County
Scotts Bluff County
Seward County
Sheridan County
Sherman County
Sioux County
Stanton County
Thayer County
Thomas County
Thurston County
Valley County
Washington County
Wayne County
Webster County
Wheeler County
York County
Nevada County
*
Churchill County
Clark County
Douglas County
Elko County
Esmeralda County
Eureka County
Humboldt County
Lander County
Lincoln County
Lyon County
Mineral County
Nye County
Pershing County
Storey County
Washoe County
White Pine County
Carson City
New Hampshire County
*
Belknap County
Carroll County
Cheshire County
Coos County
Grafton County
Hillsborough County
Merrimack County
Rockingham County
Strafford County
Sullivan County
New Jersey County
*
Atlantic County
Bergen County
Burlington County
Camden County
Cape May County
Cumberland County
Essex County
Gloucester County
Hudson County
Hunterdon County
Mercer County
Middlesex County
Monmouth County
Morris County
Ocean County
Passaic County
Salem County
Somerset County
Sussex County
Union County
Warren County
New Mexico County
*
Bernalillo County
Catron County
Chaves County
Cibola County
Colfax County
Curry County
De Baca County
Doña Ana County
Eddy County
Grant County
Guadalupe County
Harding County
Hidalgo County
Lea County
Lincoln County
Los Alamos County
Luna County
McKinley County
Mora County
Otero County
Quay County
Rio Arriba County
Roosevelt County
Sandoval County
San Juan County
San Miguel County
Santa Fe County
Sierra County
Socorro County
Taos County
Torrance County
Union County
Valencia County
New York County
*
Albany County
Allegany County
Bronx County
Broome County
Cattaraugus County
Cayuga County
Chautauqua County
Chemung County
Chenango County
Clinton County
Columbia County
Cortland County
Delaware County
Dutchess County
Erie County
Essex County
Franklin County
Fulton County
Genesee County
Greene County
Hamilton County
Herkimer County
Jefferson County
Kings County
Lewis County
Livingston County
Madison County
Monroe County
Montgomery County
Nassau County
New York County
Niagara County
Oneida County
Onondaga County
Ontario County
Orange County
Orleans County
Oswego County
Otsego County
Putnam County
Queens County
Rensselaer County
Richmond County
Rockland County
St. Lawrence County
Saratoga County
Schenectady County
Schoharie County
Schuyler County
Seneca County
Steuben County
Suffolk County
Sullivan County
Tioga County
Tompkins County
Ulster County
Warren County
Washington County
Wayne County
Westchester County
Wyoming County
Yates County
North Carolina County
*
Alamance County
Alexander County
Alleghany County
Anson County
Ashe County
Avery County
Beaufort County
Bertie County
Bladen County
Brunswick County
Buncombe County
Burke County
Cabarrus County
Caldwell County
Camden County
Carteret County
Caswell County
Catawba County
Chatham County
Cherokee County
Chowan County
Clay County
Cleveland County
Columbus County
Craven County
Cumberland County
Currituck County
Dare County
Davidson County
Davie County
Duplin County
Durham County
Edgecombe County
Forsyth County
Franklin County
Gaston County
Gates County
Graham County
Granville County
Greene County
Guilford County
Halifax County
Harnett County
Haywood County
Henderson County
Hertford County
Hoke County
Hyde County
Iredell County
Jackson County
Johnston County
Jones County
Lee County
Lenoir County
Lincoln County
McDowell County
Macon County
Madison County
Martin County
Mecklenburg County
Mitchell County
Montgomery County
Moore County
Nash County
New Hanover County
Northampton County
Onslow County
Orange County
Pamlico County
Pasquotank County
Pender County
Perquimans County
Person County
Pitt County
Polk County
Randolph County
Richmond County
Robeson County
Rockingham County
Rowan County
Rutherford County
Sampson County
Scotland County
Stanly County
Stokes County
Surry County
Swain County
Transylvania County
Tyrrell County
Union County
Vance County
Wake County
Warren County
Washington County
Watauga County
Wayne County
Wilkes County
Wilson County
Yadkin County
Yancey County
North Dakota County
*
Adams County
Barnes County
Benson County
Billings County
Bottineau County
Bowman County
Burke County
Burleigh County
Cass County
Cavalier County
Dickey County
Divide County
Dunn County
Eddy County
Emmons County
Foster County
Golden Valley County
Grand Forks County
Grant County
Griggs County
Hettinger County
Kidder County
LaMoure County
Logan County
McHenry County
McIntosh County
McKenzie County
McLean County
Mercer County
Morton County
Mountrail County
Nelson County
Oliver County
Pembina County
Pierce County
Ramsey County
Ransom County
Renville County
Richland County
Rolette County
Sargent County
Sheridan County
Sioux County
Slope County
Stark County
Steele County
Stutsman County
Towner County
Traill County
Walsh County
Ward County
Wells County
Williams County
Ohio County
*
Adams County
Allen County
Ashland County
Ashtabula County
Athens County
Auglaize County
Belmont County
Brown County
Butler County
Carroll County
Champaign County
Clark County
Clermont County
Clinton County
Columbiana County
Coshocton County
Crawford County
Cuyahoga County
Darke County
Defiance County
Delaware County
Erie County
Fairfield County
Fayette County
Franklin County
Fulton County
Gallia County
Geauga County
Greene County
Guernsey County
Hamilton County
Hancock County
Hardin County
Harrison County
Henry County
Highland County
Hocking County
Holmes County
Huron County
Jackson County
Jefferson County
Knox County
Lake County
Lawrence County
Licking County
Logan County
Lorain County
Lucas County
Madison County
Mahoning County
Marion County
Medina County
Meigs County
Mercer County
Miami County
Monroe County
Montgomery County
Morgan County
Morrow County
Muskingum County
Noble County
Ottawa County
Paulding County
Perry County
Pickaway County
Pike County
Portage County
Preble County
Putnam County
Richland County
Ross County
Sandusky County
Scioto County
Seneca County
Shelby County
Stark County
Summit County
Trumbull County
Tuscarawas County
Union County
Van Wert County
Vinton County
Warren County
Washington County
Wayne County
Williams County
Wood County
Wyandot County
Oklahoma County
*
Adair County
Alfalfa County
Atoka County
Beaver County
Beckham County
Blaine County
Bryan County
Caddo County
Canadian County
Carter County
Cherokee County
Choctaw County
Cimarron County
Cleveland County
Coal County
Comanche County
Cotton County
Craig County
Creek County
Custer County
Delaware County
Dewey County
Ellis County
Garfield County
Garvin County
Grady County
Grant County
Greer County
Harmon County
Harper County
Haskell County
Hughes County
Jackson County
Jefferson County
Johnston County
Kay County
Kingfisher County
Kiowa County
Latimer County
Le Flore County
Lincoln County
Logan County
Love County
McClain County
McCurtain County
McIntosh County
Major County
Marshall County
Mayes County
Murray County
Muskogee County
Noble County
Nowata County
Okfuskee County
Oklahoma County
Okmulgee County
Osage County
Ottawa County
Pawnee County
Payne County
Pittsburg County
Pontotoc County
Pottawatomie County
Pushmataha County
Roger Mills County
Rogers County
Seminole County
Sequoyah County
Stephens County
Texas County
Tillman County
Tulsa County
Wagoner County
Washington County
Washita County
Woods County
Woodward County
Oregon County
*
Baker County
Benton County
Clackamas County
Clatsop County
Columbia County
Coos County
Crook County
Curry County
Deschutes County
Douglas County
Gilliam County
Grant County
Harney County
Hood River County
Jackson County
Jefferson County
Josephine County
Klamath County
Lake County
Lane County
Lincoln County
Linn County
Malheur County
Marion County
Morrow County
Multnomah County
Polk County
Sherman County
Tillamook County
Umatilla County
Union County
Wallowa County
Wasco County
Washington County
Wheeler County
Yamhill County
Pennsylvania County
*
Adams County
Allegheny County
Armstrong County
Beaver County
Bedford County
Berks County
Blair County
Bradford County
Bucks County
Butler County
Cambria County
Cameron County
Carbon County
Centre County
Chester County
Clarion County
Clearfield County
Clinton County
Columbia County
Crawford County
Cumberland County
Dauphin County
Delaware County
Elk County
Erie County
Fayette County
Forest County
Franklin County
Fulton County
Greene County
Huntingdon County
Indiana County
Jefferson County
Juniata County
Lackawanna County
Lancaster County
Lawrence County
Lebanon County
Lehigh County
Luzerne County
Lycoming County
McKean County
Mercer County
Mifflin County
Monroe County
Montgomery County
Montour County
Northampton County
Northumberland County
Perry County
Philadelphia County
Pike County
Potter County
Schuylkill County
Snyder County
Somerset County
Sullivan County
Susquehanna County
Tioga County
Union County
Venango County
Warren County
Washington County
Wayne County
Westmoreland County
Wyoming County
York County
Rhode Island County
*
Bristol County
Kent County
Newport County
Providence County
Washington County
South Carolina County
*
Abbeville County
Aiken County
Allendale County
Anderson County
Bamberg County
Barnwell County
Beaufort County
Berkeley County
Calhoun County
Charleston County
Cherokee County
Chester County
Chesterfield County
Clarendon County
Colleton County
Darlington County
Dillon County
Dorchester County
Edgefield County
Fairfield County
Florence County
Georgetown County
Greenville County
Greenwood County
Hampton County
Horry County
Jasper County
Kershaw County
Lancaster County
Laurens County
Lee County
Lexington County
McCormick County
Marion County
Marlboro County
Newberry County
Oconee County
Orangeburg County
Pickens County
Richland County
Saluda County
Spartanburg County
Sumter County
Union County
Williamsburg County
York County
South Dakota County
*
Aurora County
Beadle County
Bennett County
Bon Homme County
Brookings County
Brown County
Brule County
Buffalo County
Butte County
Campbell County
Charles Mix County
Clark County
Clay County
Codington County
Corson County
Custer County
Davison County
Day County
Deuel County
Dewey County
Douglas County
Edmunds County
Fall River County
Faulk County
Grant County
Gregory County
Haakon County
Hamlin County
Hand County
Hanson County
Harding County
Hughes County
Hutchinson County
Hyde County
Jackson County
Jerauld County
Jones County
Kingsbury County
Lake County
Lawrence County
Lincoln County
Lyman County
McCook County
McPherson County
Marshall County
Meade County
Mellette County
Miner County
Minnehaha County
Moody County
Pennington County
Perkins County
Potter County
Roberts County
Sanborn County
Shannon County
Spink County
Stanley County
Sully County
Todd County
Tripp County
Turner County
Union County
Walworth County
Yankton County
Ziebach County
Tennessee County
*
Anderson County
Bedford County
Benton County
Bledsoe County
Blount County
Bradley County
Campbell County
Cannon County
Carroll County
Carter County
Cheatham County
Chester County
Claiborne County
Clay County
Cocke County
Coffee County
Crockett County
Cumberland County
Davidson County
Decatur County
DeKalb County
Dickson County
Dyer County
Fayette County
Fentress County
Franklin County
Gibson County
Giles County
Grainger County
Greene County
Grundy County
Hamblen County
Hamilton County
Hancock County
Hardeman County
Hardin County
Hawkins County
Haywood County
Henderson County
Henry County
Hickman County
Houston County
Humphreys County
Jackson County
Jefferson County
Johnson County
Knox County
Lake County
Lauderdale County
Lawrence County
Lewis County
Lincoln County
Loudon County
McMinn County
McNairy County
Macon County
Madison County
Marion County
Marshall County
Maury County
Meigs County
Monroe County
Montgomery County
Moore County
Morgan County
Obion County
Overton County
Perry County
Pickett County
Polk County
Putnam County
Rhea County
Roane County
Robertson County
Rutherford County
Scott County
Sequatchie County
Sevier County
Shelby County
Smith County
Stewart County
Sullivan County
Sumner County
Tipton County
Trousdale County
Unicoi County
Union County
Van Buren County
Warren County
Washington County
Wayne County
Weakley County
White County
Williamson County
Wilson County
Texas County
*
Anderson County
Andrews County
Angelina County
Aransas County
Archer County
Armstrong County
Atascosa County
Austin County
Bailey County
Bandera County
Bastrop County
Baylor County
Bee County
Bell County
Bexar County
Blanco County
Borden County
Bosque County
Bowie County
Brazoria County
Brazos County
Brewster County
Briscoe County
Brooks County
Brown County
Burleson County
Burnet County
Caldwell County
Calhoun County
Callahan County
Cameron County
Camp County
Carson County
Cass County
Castro County
Chambers County
Cherokee County
Childress County
Clay County
Cochran County
Coke County
Coleman County
Collin County
Collingsworth County
Colorado County
Comal County
Comanche County
Concho County
Cooke County
Coryell County
Cottle County
Crane County
Crockett County
Crosby County
Culberson County
Dallam County
Dallas County
Dawson County
Deaf Smith County
Delta County
Denton County
DeWitt County
Dickens County
Dimmit County
Donley County
Duval County
Eastland County
Ector County
Edwards County
Ellis County
El Paso County
Erath County
Falls County
Fannin County
Fayette County
Fisher County
Floyd County
Foard County
Fort Bend County
Franklin County
Freestone County
Frio County
Gaines County
Galveston County
Garza County
Gillespie County
Glasscock County
Goliad County
Gonzales County
Gray County
Grayson County
Gregg County
Grimes County
Guadalupe County
Hale County
Hall County
Hamilton County
Hansford County
Hardeman County
Hardin County
Harris County
Harrison County
Hartley County
Haskell County
Hays County
Hemphill County
Henderson County
Hidalgo County
Hill County
Hockley County
Hood County
Hopkins County
Houston County
Howard County
Hudspeth County
Hunt County
Hutchinson County
Irion County
Jack County
Jackson County
Jasper County
Jeff Davis County
Jefferson County
Jim Hogg County
Jim Wells County
Johnson County
Jones County
Karnes County
Kaufman County
Kendall County
Kenedy County
Kent County
Kerr County
Kimble County
King County
Kinney County
Kleberg County
Knox County
Lamar County
Lamb County
Lampasas County
La Salle County
Lavaca County
Lee County
Leon County
Liberty County
Limestone County
Lipscomb County
Live Oak County
Llano County
Loving County
Lubbock County
Lynn County
McCulloch County
McLennan County
McMullen County
Madison County
Marion County
Martin County
Mason County
Matagorda County
Maverick County
Medina County
Menard County
Midland County
Milam County
Mills County
Mitchell County
Montague County
Montgomery County
Moore County
Morris County
Motley County
Nacogdoches County
Navarro County
Newton County
Nolan County
Nueces County
Ochiltree County
Oldham County
Orange County
Palo Pinto County
Panola County
Parker County
Parmer County
Pecos County
Polk County
Potter County
Presidio County
Rains County
Randall County
Reagan County
Real County
Red River County
Reeves County
Refugio County
Roberts County
Robertson County
Rockwall County
Runnels County
Rusk County
Sabine County
San Augustine County
San Jacinto County
San Patricio County
San Saba County
Schleicher County
Scurry County
Shackelford County
Shelby County
Sherman County
Smith County
Somervell County
Starr County
Stephens County
Sterling County
Stonewall County
Sutton County
Swisher County
Tarrant County
Taylor County
Terrell County
Terry County
Throckmorton County
Titus County
Tom Green County
Travis County
Trinity County
Tyler County
Upshur County
Upton County
Uvalde County
Val Verde County
Van Zandt County
Victoria County
Walker County
Waller County
Ward County
Washington County
Webb County
Wharton County
Wheeler County
Wichita County
Wilbarger County
Willacy County
Williamson County
Wilson County
Winkler County
Wise County
Wood County
Yoakum County
Young County
Zapata County
Zavala County
Utah County
*
Beaver County
Box Elder County
Cache County
Carbon County
Daggett County
Davis County
Duchesne County
Emery County
Garfield County
Grand County
Iron County
Juab County
Kane County
Millard County
Morgan County
Piute County
Rich County
Salt Lake County
San Juan County
Sanpete County
Sevier County
Summit County
Tooele County
Uintah County
Utah County
Wasatch County
Washington County
Wayne County
Weber County
Vermont County
*
Addison County
Bennington County
Caledonia County
Chittenden County
Essex County
Franklin County
Grand Isle County
Lamoille County
Orange County
Orleans County
Rutland County
Washington County
Windham County
Windsor County
Virginia County
*
Accomack County
Albemarle County
Alleghany County
Amelia County
Amherst County
Appomattox County
Arlington County
Augusta County
Bath County
Bedford County
Bland County
Botetourt County
Brunswick County
Buchanan County
Buckingham County
Campbell County
Caroline County
Carroll County
Charles City County
Charlotte County
Chesterfield County
Clarke County
Craig County
Culpeper County
Cumberland County
Dickenson County
Dinwiddie County
Essex County
Fairfax County
Fauquier County
Floyd County
Fluvanna County
Franklin County
Frederick County
Giles County
Gloucester County
Goochland County
Grayson County
Greene County
Greensville County
Halifax County
Hanover County
Henrico County
Henry County
Highland County
Isle of Wight County
James City County
King and Queen County
King George County
King William County
Lancaster County
Lee County
Loudoun County
Louisa County
Lunenburg County
Madison County
Mathews County
Mecklenburg County
Middlesex County
Montgomery County
Nelson County
New Kent County
Northampton County
Northumberland County
Nottoway County
Orange County
Page County
Patrick County
Pittsylvania County
Powhatan County
Prince Edward County
Prince George County
Prince William County
Pulaski County
Rappahannock County
Richmond County
Roanoke County
Rockbridge County
Rockingham County
Russell County
Scott County
Shenandoah County
Smyth County
Southampton County
Spotsylvania County
Stafford County
Surry County
Sussex County
Tazewell County
Warren County
Washington County
Westmoreland County
Wise County
Wythe County
York County
Alexandria city
Bedford city
Bristol city
Buena Vista city
Charlottesville city
Chesapeake city
Colonial Heights city
Covington city
Danville city
Emporia city
Fairfax city
Falls Church city
Franklin city
Fredericksburg city
Galax city
Hampton city
Harrisonburg city
Hopewell city
Lexington city
Lynchburg city
Manassas city
Manassas Park city
Martinsville city
Newport News city
Norfolk city
Norton city
Petersburg city
Poquoson city
Portsmouth city
Radford city
Richmond city
Roanoke city
Salem city
Staunton city
Suffolk city
Virginia Beach city
Waynesboro city
Williamsburg city
Winchester city
Washington County
*
Adams County
Asotin County
Benton County
Chelan County
Clallam County
Clark County
Columbia County
Cowlitz County
Douglas County
Ferry County
Franklin County
Garfield County
Grant County
Grays Harbor County
Island County
Jefferson County
King County
Kitsap County
Kittitas County
Klickitat County
Lewis County
Lincoln County
Mason County
Okanogan County
Pacific County
Pend Oreille County
Pierce County
San Juan County
Skagit County
Skamania County
Snohomish County
Spokane County
Stevens County
Thurston County
Wahkiakum County
Walla Walla County
Whatcom County
Whitman County
Yakima County
West Virginia County
*
Barbour County
Berkeley County
Boone County
Braxton County
Brooke County
Cabell County
Calhoun County
Clay County
Doddridge County
Fayette County
Gilmer County
Grant County
Greenbrier County
Hampshire County
Hancock County
Hardy County
Harrison County
Jackson County
Jefferson County
Kanawha County
Lewis County
Lincoln County
Logan County
McDowell County
Marion County
Marshall County
Mason County
Mercer County
Mineral County
Mingo County
Monongalia County
Monroe County
Morgan County
Nicholas County
Ohio County
Pendleton County
Pleasants County
Pocahontas County
Preston County
Putnam County
Raleigh County
Randolph County
Ritchie County
Roane County
Summers County
Taylor County
Tucker County
Tyler County
Upshur County
Wayne County
Webster County
Wetzel County
Wirt County
Wood County
Wyoming County
Wisconsin County
*
Adams County
Ashland County
Barron County
Bayfield County
Brown County
Buffalo County
Burnett County
Calumet County
Chippewa County
Clark County
Columbia County
Crawford County
Dane County
Dodge County
Door County
Douglas County
Dunn County
Eau Claire County
Florence County
Fond du Lac County
Forest County
Grant County
Green County
Green Lake County
Iowa County
Iron County
Jackson County
Jefferson County
Juneau County
Kenosha County
Kewaunee County
La Crosse County
Lafayette County
Langlade County
Lincoln County
Manitowoc County
Marathon County
Marinette County
Marquette County
Menominee County
Milwaukee County
Monroe County
Oconto County
Oneida County
Outagamie County
Ozaukee County
Pepin County
Pierce County
Polk County
Portage County
Price County
Racine County
Richland County
Rock County
Rusk County
St. Croix County
Sauk County
Sawyer County
Shawano County
Sheboygan County
Taylor County
Trempealeau County
Vernon County
Vilas County
Walworth County
Washburn County
Washington County
Waukesha County
Waupaca County
Waushara County
Winnebago County
Wood County
Wyoming County
*
Albany County
Big Horn County
Campbell County
Carbon County
Converse County
Crook County
Fremont County
Goshen County
Hot Springs County
Johnson County
Laramie County
Lincoln County
Natrona County
Niobrara County
Park County
Platte County
Sheridan County
Sublette County
Sweetwater County
Teton County
Uinta County
Washakie County
Weston County
Chapter Assignment
Assign to Kathy
*
kderr
National
*
National
Assign to Philly
*
cairhart@akidagain.org
Philadelphia Chapter
*
Philadelphia Chapter
Assign to Indiana
*
aprzybylinski
Assign to Indiana Chapter
*
Indiana Chapter
Assign to Christine Airhart
*
cairhart@akidagain.org
Assign to Central Carolinas Chapter
*
Central Carolinas Chapter
Enrolled Child Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Gender
*
Male
Female
DOB
*
Date Format: MM slash DD slash YYYY
A Kid Again Serves Children up to the Age of 20
Select Diagnosis Category of Child (qualified life-threatening)
*
Select an Option
Brain conditions
Brain tumor
Cancer
Cerebral Palsy
Chromosomal condition
Cystic Fibrosis
Heart conditions
Muscular Dystrophy
Seizure disorder
Sickle Cell Disease
Spinal Muscular Atrophy
Spina Bifida
Other
Please Specify name of Child's Primary Diagnosis (as listed on medical records)
*
Do you have any additional Diagnoses?
*
Yes
No
Additional Diagnosis
Additional Diagnosis
Please Make a Selection
Brain conditions
Brain tumor
Cancer
Cerebral Palsy
Chromosomal condition
Cystic Fibrosis
Heart conditions
Muscular Dystrophy
Seizure disorder
Sickle Cell Disease
Spinal Muscular Atrophy
Spina Bifida
Other
Please Specify name of Child's Diagnosis (as listed on medical records)
*
Do you have any additional Diagnoses?
*
Yes
No
Additional Diagnosis 2
Additional Diagnosis
*
Please Make a Selection
Brain conditions
Brain tumor
Cancer
Cerebral Palsy
Chromosomal condition
Cystic Fibrosis
Heart conditions
Muscular Dystrophy
Seizure disorder
Sickle Cell Disease
Spinal Muscular Atrophy
Spina Bifida
Other
Please Specify name of Child's Diagnosis (as listed on medical records)
*
Do you have any additional Diagnoses?
*
Yes
No
Additional Diagnosis 3
Additional Diagnosis
*
Please Make a Selection
Brain conditions
Brain tumor
Cancer
Cerebral Palsy
Chromosomal condition
Cystic Fibrosis
Heart conditions
Muscular Dystrophy
Seizure disorder
Sickle Cell Disease
Spinal Muscular Atrophy
Spina Bifida
Other
Please Specify name of Child's Diagnosis (as listed on medical records)
*
Section Break
Does your child require wheel chair access?
*
Yes
No
Does your family have a nurse/aid?
*
Yes
No
Hospital Information
Hospital Providing Care
*
Choose Hospital
AdventHealth For Children
Advocate Children's Hospital
Akron Children's Hospital
American Family Children's Hospital
AnMed Health Women's and Children's Hospital
Ann and Robert H. Lurie Children's Hospital of Chicago
Arkansas Children's Hospital
Arnold Palmer Hospital for Children
Ascension St. John Children's Hospital
Barbara Bush Children's Hospital
Baystate Children's Hospital
Beacon Children's Hospital
Blank Children's Hospital
Blythedale Children's Hospital
Boston Children's Hospital
Bradley Hospital (Children's Psychiatric)
Brenner Children's Hospital
Bristol Myers Squibb Children's Hospital
Bronson Methodist Children's Health
C.S. Mott Children's Hospital
CAMC Women and Children's Hospital
Cardinal Glennon Children's Hospital
Cardon Children's Medical Center
Carilion Clinic Children's Hospital
Children’s Hospital at Erlanger
Children's Center at Sutter Medical Center
Children's Healthcare of Atlanta
Children's Hospital & Medical Center
Children's Hospital at Dartmouth (CHaD)
Children's Hospital at Montefiore
Children's Hospital Colorado
Children's Hospital Los Angeles
Children's Hospital of Georgia
Children's Hospital of Michigan
Children's Hospital of Nevada
Children's Hospital of New Jersey
Children's Hospital of New Orleans
Children's Hospital of Orange County
Children's Hospital of Philadelphia
Children's Hospital of Richmond at VCU
Children's Hospital of San Antonio
Children's Hospital of The King's Daughters
Children's Hospital of Wisconsin
Children's Hospital of Wisconsin-Fox Valley
Children's Hospitals and Clinics of Minnesota
Children's Medical Center Dallas
Children's Memorial Hermann Hospital
Children's Mercy Hospital
Children's Mercy Hospital Kansas
Children's National Medical Center
Children's of Alabama
Children's of Mississippi
Children's Regional Hospital at Cooper
Children's Specialized Hospital
Cincinnati Children's Hospital Medical Center
Cleveland Clinic Children's Hospital
Connecticut Children's Medical Center
Cook Children's Healthcare System
Covenant Children's Hospital
Dayton Children's Hospital
Dell Children's Medical Center of Central Texas
Doernbecher Children's Hospital
Driscoll Children's Hospital
Duke Children's Hospital
Dwaine & Cynthia Willett Children’s Hospital of Savannah
East Tennessee Children's Hospital
Edinburg Children's Hospital
El Paso Children's Hospital
Essentia Health-St. Mary’s Children’s Hospital
Floating Hospital for Children
Franciscan Hospital for Children
Gillette Children's Specialty Healthcare
Golisano Children's Hospital
Golisano Children's Hospital of Southwest Florida
Goryeb Children's Hospital
Greenville South Carolina Children's Hospital
Hasbro Children's Hospital
Hassenfeld Children's Hospital
Helen DeVos Children's Hospital
Hemby Children's Hospital
Holtz Children's Hospital
Huntsville Hospital for Women and Children
Hurley Children's Hospital
INOVA Children's Hospital
Janet Weis Children's Hospital
Jeff Gordon's Children's Hospital
Joe DiMaggio Children’s Hospital
John R. Oishei Children’s Hospital
John Sealy Children's Hospital
Johns Hopkins All Children's Hospital
Johns Hopkins Children's Center
Joseph M. Sanzari Children's Hospital
K. Hovnanian Children's Hospital
Kapi'olani Medical Center for Women & Children
Kennedy Krieger Institute
Komansky Center for Children's Health
Kravis Children's Hospital
La Rabida Children's Hospital
Lauren Small Children's Center at Bakersfield Memorial Hospital
Le Bonheur Children's Medical Center
Lehigh Valley Reilly Children’s Hospital
Levine Children's Hospital
Loma Linda University Children's Hospital
Lucile Packard Children's Hospital at Stanford
M Health Fairview Masonic Children's Hospital
Maria Fareri Children's Hospital
Mary Bridge Children's Hospital
MassGeneral Hospital for Children
Mattel Children's Hospital UCLA
Maynard Children's Hospital
Mayo Clinic – Eugenio Litta Children's Hospital
Medical City Children's Hospital
Memorial Hospital for Children
Memorial Sloan Kettering Children’s Cancer Center
Mercy Health — Children’s Hospital
Mercy Kids Children's Hospital St. Louis
Methodist Children's Hospital
Miller Children's Hospital
Monroe Carell Jr. Children's Hospital at Vanderbilt
Montana Children's Medical Center
Morgan Stanley Children's Hospital
Mt. Washington Pediatric Hospital
MUSC Shawn Jenkins Children's Hospital
Nationwide Children's Hospital
Nemours Alfred I. duPont Hospital for Children
Nemours Children's Hospital
Nicklaus Children's Hospital
Niswonger Children's Hospital
North Shore Children's Hospital
Norton Children's Hospital
Ochsner Hospital for Children
Our Lady of the Lake Children's Hospital
Palm Beach Children's Hospital
Palmetto Health Children's Hospital
Penn State Children's Hospital
Peyton Manning Children's Hospital
Phoenix Children's Hospital
Primary Children's Hospital
Providence Memorial Children's Hospital
Puerto Rico Children's Hospital
Rady Children's Hospital
Rainbow Babies & Children's Hospital
Randall Children's Hospital at Legacy Emanuel
Ranken Jordan Pediatric Bridge Hospital
Renown Children's Hospital
Riley Hospital for Children
Rocky Mountain Hospital for Children
Rush University Children's Hospital
Sacred Heart Children's Hospital
Saint Joseph's Children's Hospital
Saint Mary's Children's Hospital
Salah Foundation Children’s Hospital
San Jorge Children's Hospital
Sanford Health Children's Hospital
Scott & White Memorial Hospital Children's Hospital
Seattle Children's
Shriners Hospital for Children
Shriners Hospital for Children Los Angeles and Sacramento
St. Christopher's Hospital for Children
St. John's Children's Hospital
St. Joseph's Children's Hospital
St. Jude Children's Research Hospital
St. Louis Children's Hospital
St. Luke's Children's Hospital
St. Mary's Hospital for Children
Steven and Alexandra Cohen Children's Medical Center of New York
Stony Brook Children's Hospital
Studer Family Children's Hospital
Sunrise Children's Hospital
Texas Children's Hospital
Texas Scottish Rite Hospital for Children
The Children’s Hospital at Saint Peter's University Hospital
The Children's Hospital at HCMC
The Children's Hospital at Providence
The Children's Hospital at Saint Francis
The Children's Hospital at The Medical Center of Central Georgia
The Children's Hospital of Illinois
The Children's Hospital of Oklahoma
The Herman & Walter Samuelson Children's Hospital at Sinai
Toledo Children's Hospital
UC Davis Medical Center
UCSF Benioff Children's Hospital
UCSF Benioff Children's Hospital Oakland
UF Health Shands Children's Hospital
UMass Memorial Children's Medical Center
UNC Children's Hospital
University Hospital Pediatrics
University of Chicago Comer Children's Hospital
University of Iowa Stead Family Children's Hospital
University of Kentucky Children's Hospital
University of Maryland Children's Hospital
University of Missouri Women's and Children's Hospital
University of Vermont Children's Hospital
University of Virginia Children's Hospital
University Pediatric Hospital (Medical Science Campus)
Unterberg Children Hospital
UPMC Children's Hospital of Pittsburgh
Upstate Golisano Children's Hospital
USA Children's and Women's Hospital
Valley Children's Hospital
West Virginia University Children's Hospital
Wolfson Children's Hospital
Women & Infants Hospital of Rhode Island
Yale-New Haven Children's Hospital
Other Please List Below
Other Hospital or Medical Center
*
Social Worker/Medical Provider
By completing the below information, you are providing permission for A Kid Again to reach out to your social worker to request medical authorization. If we are unable to complete this request an A Kid Again representative will reach out for additional support.
Name of Social Worker/Medical Provider
First
Last
Email of Social Worker/Medical Provider
Parent/Guardian Information
Full Name of Mother/Father/Guardian #1
*
First
Last
Relationship
Parent/Guardian
Reciprocal Relationship
Child
Does the Guardian listed above live at the same address as the child?
*
Yes
No
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have an additional Parent/Guardian to enter?
*
Yes
No
Second Parent/Guardian
Full Name of Father/Mother/Guardian #2
*
First
Last
Does the Guardian listed above live at the same address as the child?
*
Yes
No
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contact Information
Primary Phone Type
*
Cell
Home
Primary Phone Number
*
Alternate Phone Type
Cell
Home
Alternate Phone Number
Primary Email
*
Secondary Email
Does your Child Have any Siblings?
*
Yes
No
Please add each sibling that lives in the household of the enrolled child.
Sibling Information
Please add information for each sibling that lives in the household of the enrolled child.
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 2
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 3
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 4
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 5
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 6
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 7
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 8
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 9
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Does your child have any additional siblings?
*
Yes
No
Sibling 10
Name
*
First
Last
Gender
*
Male
Female
DOB:
*
Date Format: MM slash DD slash YYYY
Foster Parents
Are you foster parents for other children or any of those listed above?
*
Please Select
No
Yes
Please note: We must receive a copy of the legal documents if you have custody of someone else’s child(ren), or if you are a foster parent of a child prior to their participation in A Kid Again.
Please upload legal documentation.
*
Accepted file types: jpg, png, pdf.
Acceptable file formats are jpg, png, or pdf
Liability Waiver
By my signature set forth below, and in consideration of A Kid Again, taking myself, my spouse, my children and any or all of my family on any "A Kid Again" outings, I hereby release A Kid Again and all of its agents, officers, servants, directors, employees, the donors, contributors, volunteers, and or participants from any liability whatsoever, in connection with the preparation, execution, and fulfillment of any and all outings on behalf of the above-mentioned child. The scope of this release shall include but not be limited to transportation, food, lodging, medical concerns (physical and emotional), entertainment, photographs, and physical injury of any kind.
Additional Liability Release and Authorization
Promotional Materials and Social Media: In order to further its mission, A Kid Again, through its agents, directors, officers, servants, or employees, periodically photographs, films, and/or electronically records interviews with parents or guardians. Those materials may be distributed now or at any time in the future to anyone including the general public, magazines, radio stations, TV stations, newspapers, public presentations, social media, or other media outlets, or displayed on A Kid Again’s website. A Kid Again also maintains social media accounts on networks such as Facebook, Instagram, and Twitter. Through these networks, A Kid Again desires to share posts welcoming new participants and posting photos and other information of participants at outings. This may include information regarding the participant’s name and/or medical condition.
Accordingly (please select one of the following)
*
Yes! By my signature below I/we authorize A Kid Again to photograph, film, or electronically record me/us and distribute such materials as A Kid Again chooses. By my signature below, I also authorize A Kid Again to post updates or photographs of me/my child on social media which may include our names and/or my child’s medical condition.
No. I do not authorize A Kid Again to photograph, film, or electronically record me/us and distribute such materials. I do not authorize A Kid Again to post updates or photographs of me/my child on social media. I understand that most A Kid Again events take place in a group setting. Therefore, I understand that it is my/our responsibility to excuse ourselves and my child from situations where it is reasonably understood that A Kid Again is photographing, filming, or electronically recording participants, and to promptly notify A Kid Again of my/our and my/our child’s non-participation. In the event I/we do not excuse ourselves or promptly notify A Kid Again of our non-participation, I hereby waive my/our and my child’s non-participation in that instance.
I hereby acknowledge that in no event will A Kid Again be held in anyway responsible for photographs, films, recordings, including social media posts, of me/us and my child taken by third parties at A Kid Again outings. I hereby state that I have read the forgoing release and have executed it freely, voluntarily and without remuneration. I give my permission for myself and/or children to participate in A Kid Again outings as outlined herein.
Research Studies
At times, the administration of A Kid Again (“AKA”) may initiate non-clinical research studies directed by our staff or through an outside research organization. These studies will help us evaluate AKA’s program by surveying family satisfaction and by analyzing the impact on the medial/psychosocial outcomes of the children who AKA serves. The goal of these studies is to ensure that AKA’s program is meeting the needs of the children and families it serves as well as to quantify its impact on treatment outcomes. By signing this consent form, you are agreeing to allow AKA staff members or their agents to contact you to discuss your family’s experience with AKA or to seek your specific consent to participate in a research study analyzing outcomes. AKA and its agents will keep any information regarding your child’s condition and treatment confidential, and neither AKA nor its agents will use or otherwise disclose information regarding your child’s condition or treatment for any other the purpose or to any other party.
Parent/Guardian Signature
*
Parent/Guardian Name
*
First
Last
Date
*
Date Format: MM slash DD slash YYYY
Personal Information
We collect this data for grant applications that will help provide more Adventures and support for our families. Grants may ask for demographic information such as income, race, religion, school district, etc.
Race of enrolled child
*
White, Non-Hispanic
African American
Latino
American Indian/Alaska Native
Asian
Pacific Islander
Middle Eastern
Other (specify below)
I'd prefer not to answer
Other (race of enrolled child):
*
Annual Household Income
*
Select an answer
0-30K
31K-55K
56K-75K
76K-100K
101K-150K
150K+
I'd prefer not to answer
Name of School enrolled child attends:
Name of health insurance carrier:
*
Please Make A Selection
Anthem
Aetna
BCBS
CareSource
Cigna
Humana
UHC
Other (specify below)
I'd prefer not answer
Other (health insurance carrier):
*
Do you have regular access to internet?
*
Select an Option
Yes
No
Employer Information
During our Annual Corporate Fundraising Campaign we are routinely asked by corporations if any of our parents work for that particular corporation. Corporations are more likely to support a cause if they know that it will benefit their employees.
Employer for Mother/Guardian #1
Employer for Father/Guardian #2
How did you hear about A Kid Again?
*
Facebook
Twitter
Other Social Media
Another Family
School
Internet
TV/Radio/News
Hospital/Medical facility
Other (specify below)
Other (how did you hear about us):
Can any immediate family members can be classified in one of these categories?
LGBTQ+
Military - Currently Enlisted
Military - Veteran
Additional languages used in the home
Arabic
French
Mandarin
Sign Language
Somali
Spanish
Other (specify below)
Other (language)
*
Constituent Code
Pending Family
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