Baby Dedication Form
All dedications are scheduled for Sundays at 11:30 am.
Name
First Name
Last Name
Contact Number
Format: (000) 000-0000.
Email Address
example@example.com
Dedication Information
First Date Choice for Dedication
 -
Month
 -
Day
Year
Date
Second Date Choice
 -
Month
 -
Day
Year
Date
Third Date Choice
 -
Month
 -
Day
Year
Date
Baby's Name
First Name
Last Name
Baby's Date of Birth
 -
Month
 -
Day
Year
Date
Baby's City & State of Birth
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Name
First Name
Last Name
Father's Name
First Name
Last Name
Will Grandparents attend the dedication?
Yes
No
Grandparent's Names(mother)
First Name
Last Name
Grandparent's Names (father)
First Name
Last Name
Godparent's Names
Will godparents attend the dedication?
Yes
No
Notes/Special requirements
Please attach a picture of the baby for the certificate.
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