Birth Information & Bris/Baby Naming

Pronoun(s)

Which pronoun(s) would you like us to use?

Baby's Hebrew Name (May be added later)

Named After

Date of Birth

Hebrew Date (if known)

Date of Naming

Hebrew Date (if known)

Please have this baby's parents complete this form separately.

Pronoun(s)

Which pronoun(s) would you like us to use?

Baby's Hebrew Name (May be added later)

Named After

Date of Birth

Hebrew Date (if known)

Date of Naming

Hebrew Date (if known)

*If the baby’s parents are different from those already listed on the form, please have them complete a separate form.

Baby's parent(s) (how you would like to be referred to in any announcements):

WHC member?

YesNo

Would you like to learn more about WHC Membership?

YesNo

Please provide a copy of your driver's license (.jpg, .png, .pdf)

For official naming certificates and billing purposes, we also need the following:

Parent 1 Full English First Name

Parent 1 Full English Last Name

Parent 1 Hebrew Name

Parent 1 Email

Parent 1 phone

Street Address

City

State

Zip Code

Add another parent?

YesNo

ADDITIONAL PARENT/GUARDIAN

Parent 2 Full English First Name

Parent 2 Full English Last Name

Parent 2 Hebrew Name

Parent 2 Email

Parent 2 Phone

Same address as Parent 1?

YesNo

Street Address

City

State

Zip Code

Name of Sibling

Age

Name of Grandparents

WHC members?

YesNo

STAFF ONLY

CEREMONY INFORMATION

Officiating Clergy

Ceremony Held At

Other Location

Time

Street Address

City

State

Zip Code

NOTES

INTAKE MEETING

Clergy

Meeting Date & Time

Meeting Location

OFFICIATION FEES

TOTAL

Date Paid