BABY DEDICATION FORM
Date of Dedication:
Child’s Firstname: Lastname
( to be typed on certificate)
Child’s Date of Birth:
Day Month Year
Mother's Firstname: Lastname:
Father's Firstname: Lastname:
Address:
City: State: Zip:
Phone Number: Cell phone:
Email Address
Are you a Worker in the Church? Father Yes No
Mother Yes No
Enter the numbers as they are shown in the image above