Would you like this to be shared with the congregation?* Yes No

Your Name:*

Your Address:*

Your Phone Number:*

Your Cell Phone Number:

Your Email:*

Name of Mother:

Name of Father:

Name of Child:*

Date of Birth:*

Time of Birth:

Weight of Baby:

Length of Baby:

Hospital Name:

Is it ok to mention in church announcements?* Yes No

Notes: