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Committed to Safety: As we resume services, we are taking all necessary precautions to keep you safe while we care for you. Limited visitation is now in place. Review all our visitor policies and precautions. Get more information on COVID-19.

Birth Certificate Registration Form - The Birthplace at Alamance Regional

If you are coming to the BirthPlace at Alamance Regional to have your baby, we strongly encourage you to fill out our online birth certificate registration form to save you some paperwork once you are at the hospital.

The State of North Carolina Vital Records office requires the following questions be answered to complete your child’s birth certificate. The birth certificate is a legal document that proves your child’s age, citizenship and parentage; therefore, it is very important you provide complete and accurate responses to all of the questions below.

* Denotes required fields

Contact Information

Child's Information

* Have You Determined Baby's Legal Name?
* Do you want a Social Security number issued for your baby?

Parent 1: Birth Mother's Information

* Is your mailing address the same as your residence address?
* Highest level of schooling completed at time of delivery
* Is your household / residence inside the incorporated limits of your city or town?
* Are you Spanish / Hispanic / Latina?
* Race
Did you receive WIC benefits during pregnancy?
Did you smoke cigarettes before and/or during this pregnancy?

Preregister for Birth Care

Reduce the amount of paperwork you need to complete at the hospital by preregistering online before you go into labor.

Learn More