Dedication Form

Baby or Child Dedication

New Testament Church of God Willesden 179 High Road, Willesden London NW10 2SD
Please attach a picture of the baby/child for the certificate.

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Baby Dedications are carried out on the 1st and 3rd Sunday of each month at the 11.00am service.

Parents and guests are requested to arrive at 10.30am and remain for the duration of the service.

The Sanctuary “a place of worship” requires a modest dress code.

Thank you for your co-operation.
BABY/CHILD
Name of Child

First NameMiddle NameLast Name
Name of child

First NameMiddle NameLast Name
Gender
Name of Hospital
Where the child was born
Date of Birth

DayMonthYear
Date
Age of the Baby/Child
PARENTS
Mother's name

First NameLast Name
Father's name

First NameLast Name
Mother's Email Address
example@example.com
Father's Email Address
example@example.com
Mother's Mobile number
Father's Mobile number
Mother's home address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's home address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
GOD PARENTS
Female God Parents - First & Last Names
Male God Parents - First & Last Names
DATE OF DEDICATION
(First or Third Sunday of the Month only)
First Date Choice for Dedication

DayMonthYear
Date
Second Date Choice

DayMonthYear
Date
Notes/Special requirements
Signature
Should be Empty:

Baby or Child Dedication