ABC "Social Star of the Week" Submissions
Please fill out the information below for your child and their achievement to be highlighted on our social media profiles. You have to be a parent/patient or staff at ABC Pediatrics to participate!
Name of Parent submitting
*
First Name
Last Name
Phone Number of Parent
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Area Code
Phone Number
Name of Child
*
First Name
Last Name
Date of Achievement
*
-
Month
-
Day
Year
Date
Description of your child's achievement!
*
Submit your picture
*
Browse Files
Cancel
of
Parental Consent
*
My check indicates that I am the legal guardian of the child(ren) referenced in this submission. My check also indicates my consent and understanding that my child’s photo will or may be printed or posted on ABC Pediatrics’ company website, social media profiles, or possibly inside the ABC Pediatrics office located at 104 Tilghman Dr. Dunn, NC.
Submit
Should be Empty: