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HAPPY 10th ANNIVERSARY MACS!!!

May 17th, 1998  -  May 17th, 2008

10 years of making kids and their families smile... All this, thanks to **YOU** !!!

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Submit A Child

* - indicates a required field
Please DO NOT use ALL CAPS (upper case) when writing
 
Child's Information
First name *
Middle name *
Last name *
Child's Caringbridge
site or other site

(for our files only, will not be displayed on our site)
Age * years old
Date of birth *
Main diagnosis *
Please list the Main diagnosis using the medical name
for it. In case of heart defects, write "Multiple Heart
Defects" and then use the form below to list them all
Other diagnoses

If child has more than one diagnosis, list the other ones here
 
Biography *

Biographies need to have a minimum of 3,000 characters and no more than 7,500 characters. Below the text box you will see your text characters being counted as you type (or paste) the biography.

(We STRONGLY recommend that you write the biography on an e-mail or any text editor program, SAVE IT, then copy & paste it here. Why? You could be almost done and your lights go out... then what?? You'll have a nervous breakdown and throw the computer out the window!!! Not a good idea...)

Begin story from birth, then signs of illness,
diagnosis and what he/she has been through until today.


CHARACTER COUNT: 0 characters
(If the number of characters don't show after you paste,
just put a letter or a space at the end of your text and then erase it)
 

Child's Interests *

i.e. cartoons, toys, hobbies
Abilities *
See notes
Hear notes
Talk notes
Walk notes
Read notes
Use hands notes
Family's Information

Checkbox selected - display name
Checkbox not selected - do not display name

Father's full name *
Mother's full name *
Stepfather's full name (if applicable)
Stepmother's full name (if applicable)
Marital status (from biological parent)
Marital status (at present time)
Guardian's full name (if applicable)
Home address *
City *
State *
Zip *
Home phone *
Cell phone
Work phone (father)
Work phone (mother)
E-mail *
Religion (optional)
Please list any holidays for which
you do not wish to receive cards
i.e. Thanksgiving, Christmas, Easter...
Siblings' Information
Only child
Expecting  Baby due
Gender Name Age Date of birth
Other/more siblings
Siblings' interests

Please list Interests for EACH young sibling separately.
You may add adult siblings too but you're not required to list their interests.
Doctor's Information (doctor associated to child's main diagnosis)
Doctor's name *
Doctor's phone *
Nurse's name *
Additional Information
Preferred date to be featured
P.O. Box or Mailbox (if you already have one, if not, leave blank)

Please let us know if Box was donated and who donated it
Questions / Comments
Submitted by * If other
I am not this child's parent or legal guardian, but I have permission from this child's parent / guardian to submit this form. (We may request that a written authorization (notarized letter) from actual parent be sent to us).

Don't forget to email us pictures (link opens in a new window) if you're sending DIGITAL ones.


Please type these letters below
before clicking on "submit"

   
 *




**ATTENTION**
BEFORE you click on "submit", make sure you have
filled out all required fields marked with a red *, or else
you may lose all info and will have to start all over again!


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Our Most Recent Angels

Christine K

, age 4½
Acute Promyelocytic Leukemia

Oct 21st, 2007

Hannah D

, age 4½
Diffuse Intrinsic Pontine Glioma

Oct 4th, 2007

Marissa H

, age 5
End Stage Renal Disease

May 22nd, 2007

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