New Life Family Worship Baby Dedication Request Form

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Grace and peace, to request a Baby Dedication please complete and submit this form. Information should be submitted as you wish it to appear on the formal Certificate.

Email *

BABY'S FULL NAME (LAST NAME, FIRST NAME, MIDDLE INITIAL) *

Place of Birth (City, State)

Birthdate *

YYYY

Time of Birth *

Time

LOCATION OF DEDICATION (Address, City, State, Zip) *

REQUESTED DATE AND TIME OF DEDICATION *

FULL NAMES OF PARENTS (Last Name, First Name) *

FULL NAMES OF GODPARENTS (Last Name, First Name) *

FORM SUBMITTED BY (Full Name, Phone #, Email): *

A copy of your responses will be emailed to the address you provided.

Submit

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