Form

Community Baptist Church of Englewood

224 First Street

Englewood, NJ 07631

Phone: 201-568-6369 Fax: 201-568-3512 www.cbcofe.org

Reverend Dr. Lester W. Taylor, Jr., Senior Pastor
CBC BABY DEDICATION FORM
PLEASE NOTE: Telephone calls and inquiries will only be accepted from the mother or father of the baby.
Baby's Name: *

First Name Last Name
Baby's Date of Birth: *

- Month - Day Year
Hospital of Birth: *
Hospital City/State:
Mother's Name: *

First Name Last Name

Address: *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Phone Number: *

- Area Code Phone Number
E-mail:
Father's Name: *

First Name Last Name

Father's Address: *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Phone Number: *

- Area Code Phone Number
E-mail

Godparent #1 Name:

First Name Last Name

Godparent #1 Address:

Street Address
Street Address Line 2
City	State
Zip Code	Country

Godparent #2 Name:

First Name Last Name

Godparent #2 Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Godparent #3 Name:

First Name Last Name

Godparent #3 Address:

Street Address
Street Address Line 2
City	State
Zip Code	Country

Godparent #4 Name:

First Name Last Name

Godparent #4 Address:

Street Address
Street Address Line 2
City	State
Zip Code	Country

Godparent #5 Name:

First Name Last Name

Godparent #5 Address:

Street Address
Street Address Line 2
City	State
Zip Code	Country

Godparent #6 Name:

First Name Last Name

Godparent #6 Address:

Street Address
Street Address Line 2
City	State
Zip Code	Country

Should be Empty: