Birthday Card Enrollment Form
Please fill out this form and click submit.
Thank you for registering your child or children in our free Birthday Card program. Please provide the information requested below so we can accurately provide each of the children in your home with a special handmade card and a small birthday surprise.
Name of Adult
*
I am a/an
*
Please select one option.
Foster Parent
Adoptive Parent
Kinship Parent
Guardianship Parent
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Children's Information
Name of 1st Child
*
Gender
*
Birthdate (ex: 00/00/0000)
*
Name of 2nd Child
Gender
Birthdate (ex: 00/00/0000)
Name of 3rd Child
Gender
Birthdate (ex: 00/00/0000)
Name of 4th Child
Gender
Birthdate (ex: 00/00/0000)
Name of 5th Child
Gender
Birthdate (ex: 00/00/0000)
Name of 6th Child
Gender
Birthdate (ex: 00/00/0000)
Name of 7th Child
Gender
Birthdate (ex: 00/00/0000)
Name of 8th Child
Gender
Birthdate (ex: 00/00/0000)
Name of 9th Child
Gender
Birthdate (ex: 00/00/0000)
Submit
Description
Please fill out this form and click submit.
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