CHILD DEDICATION REGISTRATION FORM

Parent/Guardian Name

*

Parent/Guardian Name

Preferred Date

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Number of People in Your Party (for Reserved Seating)

*

Child 1:

Full Name & Nickname (if applicable)

*

Date of Birth

*

Weight & Length at Birth

*

Special Notes

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Upload (8MB)

Child 2: (if applicable)

Full Name & Nickname (if applicable)

Date of Birth

Weight & Length at Birth

Special Notes

Upload Photos Here

Upload (8MB)

Child 3: (if applicable)

Full Name & Nickname (if applicable)

Date of Birth

Weight & Length at Birth

Special Notes

Upload Photos Here

Upload (8MB)

Description

Thanks for registering your child/children for our Child Dedication Service. Please submit this information NO LATER THAN 5 DAYS prior to the service. God bless you and your family!