CHILD DEDICATION REGISTRATION

Register your infant - pre-school son or daughter for a Baby/Child Dedication by filling out the information below:

CHILD'S INFORMATION

Child's Full Name:

Date of Birth

Gender:

Male

Female

Hospital where child was born:

PARENT'S INFORMATION

Mother's Name:

Father's Name:

Best Phone Number for Contact:

Best Email Address for Contact:

Full Address (include city, state, and zip)

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