Submit your What if We Can Adventure below

*Fields marked with an asterisk are required.

Upload your adventure photos*

Tell us more about your adventure*

Please share a description of your adventure. We want to hear as much detail as you would like to include!

Here are some ideas of what you can share:
What new activity or experience did your loved one try, and how did it make you feel?
What challenges did you and your loved one face?
How did you overcome them?
Why was this adventure special for your family?
What did you learn from this adventure that changed your perspective?

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Please confirm:

*I am a parent/legal guardian of an individual diagnosed with Rett syndrome, and if my child is 18 years of age or older, I agree that I have legal authorization to submit information about them to Acadia and provide the consents on this form on their behalf. I also agree that if I submitted information about my other children, I have legal authorization to do so and to provide the consents on this form on their behalf.

Consent for Collection of Personal Information. I agree that when I provide my What if We Can Adventure (the “Adventure”), Acadia and its data processors may collect and process personal and/or health-related information about me, my child or ward, and our family for Acadia’s What if We Can Adventures program, including first and last names, contact information, photographs, and health information, including any medical conditions, symptoms, diagnoses, medications, and any other health-related data that is contained in my Adventure submission.

I understand that if I consent, Acadia will use this information to allow me and my child to participate in its What if We Can Adventures program, contact me for further information, and disclose any details and photographs we provide, including in our Adventure submission, to the general public on Acadia websites, apps, and social media pages/platforms and in Acadia materials for Acadia’s commercial purposes.

I understand that I am not required to consent to this use and disclosure of our information. However, if I do not consent, my child or ward, our family, and I will not be able to participate in Acadia’s What if We Can Adventures program, as collection and disclosure of our information is necessary for Acadia to facilitate our participation.

If I consent, I have the right to withdraw consent on behalf of myself and my child at any time by contacting Acadia at
privacy@acadia-pharm.com.

*I consent for the collection, processing, and disclosure of my, my child or ward’s, and our family’s personal and health-related information for the purposes described above.

*I grant Acadia permanent and enduring rights to use my, my child or ward’s, and our family’s information and likeness, as described above, for use in its What if We Can Adventures program and release Acadia from all claims related to these uses in its What if We Can Adventures program and marketing materials including, but not limited to, Acadia websites, apps, and social media pages/platforms.

*I understand and agree to Acadia’s Privacy Policy and Terms of Use

Please verify that you are human*