Birth Submission Form
Baby's full name
*
First
Middle
Last
Baby's gender
*
Male
Female
Date of birth
*
/
Month
/
Day
Year
Date
Parent 1
First Name
Last Name
Parent 2
First Name
Last Name
Additional parents (if applicable)
If applicable
Grandparent 1
First Name
Last Name
Grandparent 2
First Name
Last Name
Grandparent 3
First Name
Last Name
Grandparent 4
First Name
Last Name
Great-grandparent 1
First Name
Last Name
Great-grandparent 2
First Name
Last Name
Great-grandparent 3
First Name
Last Name
Great-grandparent 4
First Name
Last Name
Additional family members (if applicable)
If applicable
Which of the relatives listed are members of AA?
*
Photo(s)
Upload a File
Drag and drop files here
Choose a file
Providing a photo is optional, but we'd love to have one to include in our communications to the congregation!
Cancel
of
Notes/additional information (if applicable)
By checking the box below, you give us permission to release the information and pictures above in the congregation-wide e-blasts and Beineinu newsletter. Do you grant permission?
*
Yes, I grant permission
Name of person completing form
*
First Name
Last Name
Email for receipt
*
Submit
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