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
*
Mother
Father
Guardian/Other
Secondary Contact Name
*
First
Last
Secondary Contact's Relationship to Child
*
Mother
Father
Guardian/Other
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Primary Contact's Home Number
*
###
-
###
-
####
Primary Contact's Work/Cell Number
###
-
###
-
####
Primary Contact's Email
Will both parents be part of the dedication?
Yes
No
First Child's Full Name
*
First
Last
First Child's Birthdate
*
MM
/
DD
/
YYYY
First Child's Gender
*
Male
Female
Second Child's Full Name
First
Last
Second Child's Birthdate
MM
/
DD
/
YYYY
Second Child's Gender
Male
Female
Third Child's Full Name
First
Last
Third Child's Birthdate
MM
/
DD
/
YYYY
Third Child's Gender
Male
Female
Please indicate which service you plan to dedicate your child on November 22.
*
8:30
10:00
11:30
Orientation time you plan to attend on November 15.
*
8:30
11:30
Unable to attend on this day
*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