Book Information

Form Fields with an asterisk are optional*

First Name:
    Boy           Girl      
Middle Name:
*
Last Name:

Hometown:
*
Province/State:

Date book is given:

List up to three of the first visitors to see the baby.
1.   
2.   
3.   

Dedication
(With love from, etc.)


This book from
(Mommy & Daddy, etc.)

   Order Special Delivery  
Date of Birth:     
Time of Birth:    
       Weight:         
       Length:         
       Doctor 
       (midwife or nurse):    
       Hospital:                      
       First name of mother:
       First name of father:  

Version of Story Desired: Check only one box.

Standard Version:  
Single Parent Version:  

Shipping Information
If ordering online, you only need to enter your email address 
and the name of the person placing this ordering. You will be 
required to enter your name etc. when making final payment.

Ship To:

Name:  

Street:  

House Number:

City:

Province/State:

Postal Code/Zip:

Country:

Telephone Number:

e-mail Address:

Ordered By:

Any other information you think we should have for your book:

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