Form – Balloon Celebration SOFT's Annual Balloon Celebration in memory of SOFT Angel Children The annual balloon celebration will be held during the Saturday picnic. You need not be in attendance to have a balloon released for a child who has passed. Please provide the information requested below and we will ensure that a balloon is released for your child. SOFT notifies each parent for whom a balloon is released (if you are not the parent) so it is very important that the name and mailing address of the parent of the child be provided. Your FIRST and LAST Name:Please enter your address. We do not share it with anyone else except the child's parents if you are not the parent. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone (used only if we must contact you about this)Email (used only if we must contact you about this) Are you going to attend the conference? YES, we will attend the conference No, we will NOT attend the conference Your relationship to the child (parent, uncle, grandparent, friend, etc):The Child's DetailsChild's Name: FIRST, Middle if desired, LAST*Male or Female?*Date of Birth:*Date of Death:*Child's Diagnosis*Parent Name(s) if not you (so we can notify them of the balloon request). Be sure to include the LAST name.Child's Parent's address (if not your address). Don't forget the city, state and postal code:IF YOU ARE NOT THE PARENT(s) AND THE PARENT(s) DO NOT RESIDE IN THE USA, PLEASE PROVIDE THEIR EMAIL ADDRESS IN THE "COMMENTS" FIELD BELOW. THANKS!Enter any comments here:Upload a photo of the SOFT Child, if you wish.By submitting the attached images as well as child's name and diagnosis, I am granting SOFT and its representatives the right to use these images for the purposes of the balloon release and any video related to that event. I understand that the video and images might be used on the SOFT website. If I do not want to grant SOFT this right, I will not submit the name, diagnosis, or photographic image to SOFT.Don't forget to tap the SUBMIT button!