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To register to our wish program please fill out the following form.

First Name

Email Address

Last Name

Childs Name

Does the child your registering currentely suffer from a chronic illness or disability?

No

Yes

Does the child your registering reside in Australia

No

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

REGISTER A CHILD FOR A WISH!

Australian Childrens Charity
ABN: 93641828426
ACN: 641828426

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