Please print out the questionnaire, returning it with your photos and your check in the amount of $10.80 [$9.99 + .81 NYS tax] to:

SpecialAddition.com
c/o NETS
90 U.S. Highway 206
Suite 118
Stanhope, NJ 07874

Please make check payable to Network Technology Services of NJ, Inc.

PLEASE PRINT

Child's Name ________________________________________________ (Only Last Initial will be used).

Sex M/F ______________      Parent's First Names (Mom/Dad) _____________________________________

Date of Birth ____________  Time __________ AM/PM      Weight ___________         Length _________

Eye Color ______________    Hair Color (Leave blank if none) _____________________

Do you want this to be a private or public site?  ___________________________________________

- All Fields Below Are Optional -

Hospital ____________________________________ City, St ___________________________________

Doctor _____________________________________

God Parents ___________________________________________________________________________

Grand Parents _________________________________________________________________________

Comments _____________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

E-Mail Addresses: _________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

       Your Name: _________________________________________________________

        Address: ____________________________________________________________

        City, St, Zip: _________________________________________________________

        Phone: ___________________________    E-Mail: __________________________

        Relationship to Child: __________________________________________________

Please include up to 3 photos either on disk or physical photos to be scanned.   If sending physical photos, please be sure to mark your baby's name on each.  Photos will be returned only if requested.

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