Boy Girl      Name(first) (middle)* (last)

Informal name(if you want it used in the story*          Hometown

Hospital*    Dr. / Midwife *   Name*

Birthdate     Weight*     Length*     Time* AM PM

If child is adopted, date child came to live with parent(s)

Single Parent? Y N

Mother's name      Father's name

First Visitors

Dedication   Book from   Date of gift

Special instructions *

Purchased by:                                                                             Ship to: check here if same as purchaser
Name    Name

Address        Address

City/ST/Zip           City/ST/Zip

Phone (if clarification is necessary)

Email*

I heard about Redwing Enterprise Childrens Books: *
Friend          Received a book             Internet searched on key words