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 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.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Email
example@example.com
Please contact me via:

NewsletterEmail
I would like my Baby's Birthday remembered by:

Birthday Card in postMemorial birthday message posted on social media
*Please note your MUST fill in a separate form for each baby you would like us to remember*
Baby's Names
Baby's date of birth
Any details you would like us to know
Should be Empty:

Ayrshire Baby Loss Support