No More Umbrellas

Child's First and Last Name

Birthday

Month

Day

Year

Parent/Guardian First and Last Name

Phone

Address

Hospital Name

Social Worker/Provider Name

Please indicate Party Box OR Gift Box

Party box includes party supplies (plates, cups, streamers) and a gift card for a birthday cake.

Gift box small gifts and a store gift card.

Child's favorite color

Child's Favorite Character

Child's Favorite Store

Anything else you want to tell us about your child?

[Optional]

By checking this box, I give permission for No More Umbrellas Foundation to use and publish my

photographs and photographs of my children for publication, promotion, or

advertising. I hereby release the No More Umbrellas Foundation from all claims and

liability relating to said images.

I acknowledge that I am 18 years of age.

I acknowledge that I am the legal guardian of the children named above.

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