Premature Baby Birth Story Submission

Your Name (required)

Your Email (required)

Your baby's name

Your baby's gestation born

Your baby's weight when born

Days your baby spent in hospital

Your baby's current age

We can only accept 3 images for this area.

Please Note: You can either attach a word document for your birth story OR you can submit it below in the text field.

Please upload a word .doc file of your birth story

Please upload an image of your baby
(Please attach a JPG image. Maximum image size 800 by 600 pixels)

Please upload an image of your baby
(Please attach a JPG image. Maximum image size 800 by 600 pixels)

Please upload an image of your baby
(Please attach a JPG image. Maximum image size 800 by 600 pixels)

I accept that these images will be published on the L'il Aussie Prems website with my approval.
(check this box if you agree)

Paste your birth story here if you do not wish to upload it as a word .doc

(This form may take up to a minute to submit depending on how large your attached files are)