Naming your baby and birth certificate information
Please use this worksheet to give your baby’s name and your demographic information to the hospital birth registry staff. The information you provide will be used to create your child’s birth certificate. The birth certificate is a document that proves your child’s age, citizenship and parentage. This document will be used by your child throughout his/her life. State laws provide protection against unauthorized release of identifying information from birth certificates to protect the privacy of the parents and their child.
It is very important that you provide complete and accurate information to all of the questions. In addition to information used for legal purposes, other information from the birth record is used by health and medical researchers to study and improve the health of mothers and newborn infants. Items such as parents’ education, race, and lifestyle factors will be studied, but will not appear on the birth certificate issued to you or your child.
Birth records must be filed within 5 days of the birth. If you do not name your child within five (5) days, the record will be filed as “baby boy” or “baby girl” and no automatic Social Security Number can be issued, but you can change the name free of charge within 45 days of the birth.
Contact information in case the birth registrar has any questions about information contained in this form.
Phone (1) __________________________________
Phone (2) __________________________________