To help you announce the birth of your baby, we have provided this simple form that can be printed and mailed to the newspaper(s) of your choice. Please print, complete and sign this form and mail it to the newspaper address(es) of your choice. NOTE: Announcements will not be printed without the signature of each parent listed.
It is very important to provide information regarding where your baby was born:
Providence St. Vincent Medical Center ___ Providence Milwaukie Hospital ___
Providence Portland Medical Center ___ Providence Newberg Medical Center ___
Other (please specify_______________________________
Parents’ Names:
_________________________________________
Mother’s: Last First Middle Initial
_________________________________________
Father’s: Last First Middle Initial
City & State of Residence: ___________________________________
Baby’s Name: ________________________________________
Last First Middle Initial
Gender: Male ___ Female ___ First child? Yes___ No___
Date of Birth_____________ Time _______ a.m. / p.m. (circle one)
Length (inches) __________ Weight (pounds)_______ (ounces)______
Brothers & sisters (names & ages) ____________________________________________
Mother’s Parents: _______________________________________
Names Hometown & State
Father’s Parents: ________________________________________
Names Hometown & State
Great-Grandparents:________________________________________
Names Hometown & State
Mother’s Signature__________________________ Date_______
Father’s Signature __________________________ Date________
This section is very important but it will be used only if the reporter has questions; it is not for publication.
Home Phone: _________________ City: _______________ Zip Code:_________
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