Baby's Name:
	Boy:
	Girl:
	Date of Birth:
	Hospital:
	City:
	Weight:
	Length:
	Time:	PM: AM:
	Parents' Names:	Please include maiden name
	Mother
	Mother's Maiden name
	Address:
	Father:
	Address:
	Siblings:
	Name
	Age	Male Female:
	Name
	Age	Male Female:
	Name
	Age	Male Female:
	Name
	Age	Male Female:
	Name
	Age	Male Female:
	Name
	Age	Male Female:
	Grandparents:
	Name(s)
	Address
	Name(s)
	Address
	Name(s)
	Address
	Name(s)
	Address
	Great-Grandparents:
	Name(s)
	Address
	Name(s)
	Address
	Name(s)
	Address
	Name(s)
	Address
	Daytime phone contact:
	E-mail:
		Are you sending a photo? Yes No To Send photo: Contact The Post & Mail 927 W. Connexion Way, Columbia City, Indiana 46725 Phone: (260) 244-5153 or (260) 625-3879 Fax: (260) 244-7598 postandmail@earthlink.net