1st Parent/Guardian Name *

First Name

Last Name

Relationship to child *

Mother

Father

Grandparent

Guardian

2nd Parent/Guardian Name

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child #1 *

First Name

Last Name

Boy or Girl? *

Boy

Girl

Birthdate *

MM

DD

YYYY

Child #2

First Name

Last Name

Boy or Girl?

Boy

Girl

Birthdate

MM

DD

YYYY

Child #3

First Name

Last Name

Boy or Girl?

Boy

Girl

Birthdate

MM

DD

YYYY

What service will you be attending? *

The baby dedication will start at the beginning of service. We ask that you arrive 15 minutes before service starts.

8:15 AM

9:30 AM

11:00 AM