Births

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I acknowledge that the following information is correct and contains all the information I wish printed about the birth of my child. PLEASE NOTE: If the parents of the child are not married, an additional form must be signed by the father if his name is to be used in the announcement.

Signature: Date:

Telephone #:

Child's Name:

Date of Birth:

Time: (am/pm) Boy or Girl:

Place of Birth:

Weight: Length:

Parents' Names:

Parents' Address:

Maternal Grandparents (Mother's Side):

Paternal Grandparents (Father's Side):

Great Grandparents:

Child's Brothers and/or Sisters:

PERMISSION TO PRINT MY NAME
IN THE PONCA CITY NEWS

When announcing your child's birth, if the parents of the child are not married, this form must be signed by the father if his name is to be used in the announcement.

I agree to allow my name, (fathers name):

to be printed in The Ponca City News as the father of (child's name):

whose mother is (mother's name):

Father's Signature: Date:

Father's Work Phone: Home Phone:

Mail your submissions:

The Ponca City News
Lifestyles Editor
P.O. Box 191
Ponca City, OK 74602-0191

Fax your submissions:

(580) 765-7800

Phone: (580) 765-3311
Email: lifestyles@poncacitynews.com

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