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2. Due to the overwhelming support of our Make a Child Smile Event, the child you selected may have already been adopted by another family. If this is the case you will receive notification from us within 48 business hours with a similar child's information.
4. Child Identification

   Female, Age 11 

6. Family Number

   79

8. Shirt Size

   Youth Medium

10. Pants Size

    Youth Size 9-10

12. Shoe Size

    Youth Size 5.5

14. Needs

    clothes/shoes

16. Gift of Choice/Favorites

    white or pink crocs/Nike

18. First Name*
19. Last Name*
21. Email Address*
22. Phone Number*
24. Address
26. City
27. State
28. Zip Code
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field