Baby/Child Dedication Application

Registrant

First Name

Last Name

Marital Status

Spouse Name (if applicable)

Address

Campus

Home

Mobile

Your name(s) and your child(ren)'s names as you want them to appear on your certificate. **Please indicate the ages of your children being dedicated

How many will be attending? (Include guests and yourself)

Did you watch the videos?

Yes No

Please list any questions you may have here.