Child Dedication Sign-Up Form
Sunday, May 10th on Mother's Day
Child's Name
*
First Name
Middle Name
Last Name
Child's Birthday
-
Month
-
Day
Year
Date
Parent / Guardian Name
First Name
Last Name
Parent / Guardian Name
First Name
Last Name
Parent's E-mail
example@example.com
Parent's Cell
Please enter a valid phone number.
Format: (000) 000-0000.
Which service would you like for your child to be dedicated?
9:00 am
11:00 am
Please include a family photo to be used during dedication:
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