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Baby Dedication

* Indicates required field.

For Your Baby Dedication, please provide the following information listed in the form below.

A copy of the Child's Birth Certificate is required.

Please note, Baby Dedication Services are conducted the Last Sabbath (Saturday) of each Month.

Date of Form Submission

dd/mm/yyyy

Name*

First

Last

Email*

Home AddressPlease be as precise as possible

Address 1

Address 2

City

Province/State

Postal Code

Country

Home Phone Number

Cell Phone Number

Plesae provide any other necessary information.

Baby Mother's Name

First

Last

Baby Mother's Phone Number

Baby Father's Name

First

Last

Baby Father's Phone Number

Date of Birth - the baby date of birth

dd/mm/yyyy

Baby Name

First

Last

Gender*

Boy

Girl

Place of Birth*If other, please state where in the field below.

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Baby Dedication