Parent Name(s)
*
Email
*
Phone #
Child's name
First Name
Middle Name
Last Name
Child's birthday
-
Month
-
Day
Year
Date Picker Icon
Please upload a photo of your child (to show on screen, during the dedication time)
Please upload a high resolution image that is "landscape" orientation (wider than it is tall), for best display on screen.
Check this box if applicable:
I have two or more children I would like to dedicate
2nd Child's name
First Name
Middle Name
Last Name
2nd Child's birthday
-
Month
-
Day
Year
Date Picker Icon
Please upload a photo of your child (to show on screen, during the dedication time)
3rd Child's name (if applicable)
First Name
Middle Name
Last Name
3rd Child's birthday (if applicable)
-
Month
-
Day
Year
Date Picker Icon
Please upload a photo of your child (to show on screen, during the dedication time)
4th Child's name (if applicable)
First Name
Middle Name
Last Name
4th Child's birthday (if applicable)
-
Month
-
Day
Year
Date Picker Icon
Please upload a photo of your child (to show on screen, during the dedication time)
Please list any other siblings in the family
Preferred service
9:00 am
10:45 am
Submit
Should be Empty: