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Child's name

Email

Gender

Boy

Girl

Time of birth

Date of birth

Weight

Length

Hospital

Mother (include maiden name)

Father

Maternal grandparents (include city/state)

Maternal great-grandparents (include city/state)

Paternal grandparents (include city/state)

Paternal great-grandparents (include city/state)

Great-great-grandparents (include city/state)

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