RESTORATION STATION Children's Dedication Day
Name of Parents/Guardians
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
How Many Children Will Be Participating?
*
Children MUST be age 5 and under.
Child #1 Name, Age, Date of Birth, Place of Birth (Hospital name, city and state)
*
For Example: Jamie Ryan Smith, Age 5, 03/24/2020, Lourdes in Camden, NJ
Child #2 Name, Age, Date of Birth, Place of Birth (Hospital name, city and state)
*
For Example: Jamie Ryan Smith, Age 5, 03/24/2020, Lourdes in Camden, NJ
Child #3 Name, Age, Date of Birth, Place of Birth (Hospital name, city and state)
*
For Example: Jamie Ryan Smith, Age 5, 03/24/2020, Lourdes in Camden, NJ
Will there be God Parents In Attendance? Please list names below.
*
Submit
Should be Empty: