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May 19, 2013

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If parents are not married, please use this form which must be brought to the office and both parents must sign the form. Click here for complete guidelines. For more information, call 865-986-6581.

The fields for your name and email address must be filled in to process this form.
Baby is boy or girl.
Name baby will be called ("Joe")
Baby's full name ("Joseph Allan Smith")
Parents names as you wish them to appear
Of (town)
Baby's date of birth / /
Place of birth:
Birth weight, length:
Brothers, sisters (include last name)

Grandparents (names and towns)

Great-grandparents

I hereby give my consent to release the information contained herein to News-Herald.

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Father (signature and phone #)


Witness (signature and phone #)

*Must be signed by member of hospital staff if parent's last names are different.
 
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