Baby Dedication

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Provide the following information in order to schedule a baby dedication.

Father

First

Last

Mother

First

Last

Child's Name *

First

Last

Date of Birth *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Dedication Date *

Email

Paternal Grandfather

First

Last

Paternal Grandmother

First

Last

Maternal Grandfather

First

Last

Maternal Grandmother

First

Last

Godfather1

First

Last

Godmother1

First

Last

Are there other godparents *

No
Yes

Comments or special requirements

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