献児式 申込書 / Baby Dedication Application Form
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ふりがな(お名前 / Katakana ) *
例:Tarou
お子様のお名前 / Name of Child *
例:山田太郎
性別 / Gender *
生年月日 / Date of Birth *
MM
/
DD
/
YYYY
ご両親のお名前 /  Names of Parents *
住所 / Home Address
電話番号 / Telephone
E-Mail Address *
お子様のお生まれになったときの様子、お名前の由来、エピソードなどあったらお書きください。/ Please write about the meaning of the child's name, the situation of the birth. *
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