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Family Dedication Request
(More then one child) Please complete a new request for each child
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Email
*
Your email
Date of Dedication Requested
*
MM
/
DD
/
YYYY
Child's First, Middle and Last Name
*
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
Child's Birthplace (City & Province)
*
Your answer
Name of Hospital Where Child Was Born
*
Your answer
Parent's First and Last Name(s)
Your answer
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