Baby Dedication Interest Form
Please fill out this form and click submit.
Contact Information For Person Registering The Dedication
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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Dedication Information For Certificate
Father's First & Last Name
*
Mother's First & Last Name
*
Child #1 Full Name
*
Child #1 Birthdate
*
Please upload a photo of Child #1 for the dedication service.
*
Upload (8MB)
Child #2 Full Name
Child #2 Birthdate
Please upload a photo of Child #2 for the dedication service.
Upload (8MB)
Child #3 Full Name
Child #3 Birthdate
Please upload a photo of Child #3 for the dedication service.
Upload (8MB)
If you have additional children you would like to dedicate, enter their full names & birthdates.
Please choose a Baby Dedication Date:
*
Please select all that apply.
Next Available Date
Thank you for showing interest in dedicating your child. You will be contacted by a member of staff to schedule your dedication ceremony.
Submit
Description
Please fill out this form and click submit.
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