If you are a parent/guardian who wishes to express interest in the trial, please provide the information requested below.

About your child

About you

Before submitting this form, you are required to agree to the following terms. If you do not fully understand these terms or have questions, please send an email to CANaspire@aspatx.com.

• All information will be stored and processed in a confidential way, in accordance with the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA, the General Data Protection Regulation (GDPR), and Aspa Therapeutics’ parent company’s (BridgeBio) Privacy Policy.
• All information will be shared with the CANaspire investigators (study doctors) for the sole purpose of determining whether your child can be considered for screening.

By clicking the box that says "I Agree" below, you are consenting to the use of your personal information in accordance with the terms outlined above. If you do not click the “I Agree” box, no information will be sent to the Communication Coordinator and you will not receive further contact regarding the clinical trial.