Memorial Birthday's Form

Ayrshire Baby Loss Support

Personal Details Form / Birthday Announcements
We would love to remember your baby's birthday on our social media, and/or send a wee card to you. We would also love to keep you up to date about Ayrshire Baby Loss Support (ABLS).

By completing this form you are agreeing to us holding your personal information, this information will be held securely and password protected and will only be used for the purposes stated and to relay information of the work we are doing via methods agreed to on this form.

GDPR (General Data Protection Regulations) came into force on 25 May 2018.
Your Baby's Details
Baby's Name
Please enter how you would like your Baby's name recorded in the card and or post
Baby's date of birth
Please enter your baby's date of birth for our card and/or social media post
Baby's gender
I would like my Baby's Birthday remembered by:
*Please note your MUST fill in a separate form for each baby you would like us to remember by a card and/or social media post*
Your Details
Your Name

Your First NameYour Last Name
Your Address (only required if you are asking for a card in the post, if so please enter full address)

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Your Email
example@example.com
Your Phone Number
Please enter a valid phone number.Format: 00 000 000 000.
Your Relation to baby (eg. Mother, Mum, Father, Dad)
Your Partner's Details

Only provide these if you wish your partner's name to be included in the card or post
Your Partner's Name (if you would like their name included in the card / post

Your Partner's First NameYour Partner's Last Name
Your Partner's Relation to baby (eg Mother, Mum, Father, Dad)
Other Details
If you would like siblings mentioned in the card and/or post have any other details you would like us to know, you may do so here
Should be Empty:

Ayrshire Baby Loss Support

Your Baby's Details

*Please note your MUST fill in a separate form for each baby you would like us to remember by a card and/or social media post*

Your Details

Your Partner's Details

Other Details

Please note your MUST fill in a separate form for each baby you would like us to remember by a card and/or social media post