Wufoo

2009 Child Dedication

Kindly complete the information below for your child(ren).

Child Dedication Date * MM / DD / YYYY
Primary Contact's Name * First Last
The person listed will be the main point of contact.
Primary Contact's Relationship to Child *
Secondary Contact Name * First Last
Secondary Contact's Relationship to Child *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary Contact's Home Number * ### - ### - ####
Primary Contact's Work/Cell Number ### - ### - ####
Primary Contact's Email
Will both parents be part of the dedication?
First Child's Full Name * First Last
First Child's Birthdate * MM / DD / YYYY
First Child's Gender *
Second Child's Full Name First Last
Second Child's Birthdate MM / DD / YYYY
Second Child's Gender
Third Child's Full Name First Last
Third Child's Birthdate MM / DD / YYYY
Third Child's Gender
Please indicate which service you plan to dedicate your child on November 22. *
Orientation time you plan to attend on November 15. *
*Please include any phonetic notes with you or your child's name (i.e. a rhyming word) to assist us in pronouncing names correctly during the service. *
Do Not Fill This Out