Counseling: Baby Dedication
A request form for baby dedications
Date
-
Month
-
Day
Year
Date
Mother's Name
*
First Name
Last Name
Mother's Email
*
example@example.com
Mother's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Name
*
First Name
Last Name
Does father have same address as mother?
*
Yes
No
Father's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Next
Married?
*
Yes
No
If not married, are there plans to be married?
*
Yes
No
If plans for marriage, when?
*
If not married, are you willing to commit to a restoration statement before the church at/before the time of dedication?
*
Yes
No
If not married, will both parents appear at the dedication?
*
Yes
No
If only one, which one?
*
Mother
Father
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What are the plans for caring for the child?
*
If married, do you commit to stay together even for the sake of the child?
*
Yes
No
Do you commit to lead the child to faith in Christ to the best of your ability?
*
Yes
No
Do you commit to bring the child up as a Christian?
*
Yes
No
Are there any other concerns/issues we should know about before the dedication?
*
Yes
No
If yes, what are those concerns/issues?
*
Mother's Church
*
Father's Church
*
Baby's Name
*
First Name
Last Name
Baby's Gender?
*
Boy
Girl
Baby's Age (months)
*
Birth to 3 years old only
Requested Dedication Date (2nd Sundays only)
*
-
Month
-
Day
Year
Date
Approximate # of Guests Attending
*
Submit
Should be Empty: