Bris Detail Form
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Parent 1 Name (Primary Contact) *
Parent 1 Cell Phone # (Primary Contact Number) *
Parent 1 Email (Primary Contact Email) *
Parent 2 Name *
Parent 2 Cell Phone # *
Date of Birth *
MM
/
DD
/
YYYY
Time of Birth *
Time
:
Date of Bris *
MM
/
DD
/
YYYY
Time of Bris *
Time
:
Address of Bris Location *
Will your own clergy attend?  *
If your own clergy is attending, please provide their name, phone number, and email below:
Gestational age at birth *
Weight at birth *
Has baby been medically cleared for circumcision by a pediatrician? *
Did the baby receive vitamin K? *
Does the baby have any medical issues? *
If yes, please elaborate below
Baby's full English name *
Baby's full Hebrew name *
Was the baby's Hebrew name chosen to be in memory of anyone? If so, please provide their name(s) and relationship to the baby,  as you would like them to appear on the Bris certificate.
Typically, parents or other close family members give a short speech at the bris about how they chose their baby's name. Who, if anyone, will be giving this speech? 
Who will be performing the honor of lighting the candles at the beginning of the Bris? (Please provide name and relation to the baby/family, eg. "Steven Schwartz, uncle") *
Who will be performing the honor of bringing the baby into the room for the Bris? (Please provide name and relation to the baby/family) *
Who will be performing the honor of holding the baby for the beginning of the Bris? (Please provide name and relation to the baby/family) *
Who will be performing the honor of saying the HaMotzi blessing over bread at the end of the Bris? (Please provide name and relation to the baby/family) *
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