Baby Dedication Request

1
Church Location
Restoration Church International
Salvation House
2
Preferred Dedication Date* This field is required.If requested dedication date isn't available, date may be changed.
Date
Month
Day
Year
3
Child's Full Name* This field is required.
First Name
Middle Name
Last Name
4
Child's Date of Birth* This field is required.
Date
Month
Day
Year
5
Weight @ Birth
6
Length @ Birth
7
Father's Name* This field is required.
First Name
Last Name
8
Mother's Name* This field is required.
First Name
Last Name
9
Contact Email* This field is required.
10
Contact Phone* This field is required.
11
Relatives that will be attending the baby dedication:
Please include full names & their relationship to the child.
12
Child's PhotoPlease provide a photo to be displayed during the dedication service.
Drag and drop files here
Select files to upload
Max. file size: 1.0MB
Cancelof
Should be Empty: