Submission Form "*" indicates required fields Baby's Name* Baby's Sex*Please selectMaleFemaleDate of Birth* Month Day Year Birth Weight* Name of Parents* First Last Name of Parents First Last Who was the Doctor?*Please selectDr. CopeDr. BurtonDr. JenningsDr. GibbsDr. JonesDr. ShenkerAdditional Information to ShareAttach a Picture*Accepted file types: jpg, jpeg, png, gif, Max. file size: 1 MB.Signature of Parent or Legal Guardian* Phone*Email* Date* Month Day Year PhoneThis field is for validation purposes and should be left unchanged. 7763