Baby Dedication Request Form
In order for your baby dedication request form to be considered, you must be a member of Wheeler Avenue Baptist Church. Are you a member?
*
Please Select
Yes
No
Child's Name
*
Child's Gender
*
Adopted? (This info will be kept confidential)
*
Please Select
No
Yes
Date of Birth
*
-
Month
-
Day
Year
Date
Mother's Full Name
*
First Name
Last Name
Father's Name
*
First Name
Last Name
Godmother's Full Name
*
First Name
Last Name
Godfather's Full Name
*
First Name
Last Name
Parent's Home Address
City
State
Zip
Parents Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Requested Month of Dedication
Have you dedicated other children at Wheeler?
Please Select
Yes
No
If yes, when?
Please verify that you are human
*
Submit
Should be Empty: