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*Name
of Baby:
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*Sex of Baby:
*Weight:
*Length:
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*Date of Birth: (mm/dd/yyyy)
*Time of Birth:
(hh:mm)
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*Place
of Birth:
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Maternal Grandparents
& Address:
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example: Pete Doe
(father) and Sarah Doe (mother); 123 Thisisastreet St., City, State
12345 COUNTRY
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Paternal Grandparents
& Address:
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Maternal
Great-grandparents & Address:
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example: Pete Doe
(father) and Sarah Doe (mother); 123 Thisisastreet St., City, State
12345 COUNTRY
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Maternal
Great-grandparents & Address:
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Paternal
Great-grandparents & Address:
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Paternal
Great-grandparents & Address:
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Brothers: (Include
ages)
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Sisters: (Include
Ages)
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*Name and telephone
number of person supplying this information:
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example: John Doe (555) 555-5555
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*Contact E-mail
Address. Please supply your
e-mail address in case we need to contact you electronically.
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