New Salem Baby Dedication Request Form
We are glad you have taken an interest in the Baby Dedications here at New Salem Missionary Baptist Church. The requirements to participate are that you are a member and that the baby is 12 months or younger.

Once you complete the registration, you will receive an E-Mail that will be your confirmation that you are on the schedule. Dedications take place on every 5th Sunday immediately following the 10:45 am services in the F.C. Chapel. You are encouraged to invite family and friends to attend.

If you have any questions or concerns, please contact Mrs. Joy Brewton, Pastoral Office at (614) 930-2204.

Child's Information
Child's Last Name *
Your answer
Child's Middle Name *
Your answer
Child's First Name *
Your answer
Date of Birth *
Example: 01/01/2012
Your answer
Child's Gender *
Required
Parent's Information
Mother's Last Name
Your answer
Mother's First Name
Your answer
Are you a member of New Salem?
Mother's Home Telephone
Your answer
Mother's Work Telephone
Your answer
Mother's Email *
Your answer
Father's Last Name
Your answer
Father's First Name
Your answer
Father's Email
Your answer
Mother's Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Are parents married?
Father's Address (if different from mother's)
Your answer
Father's City (if different from mother's)
Your answer
Father's State (if different from mother's)
Your answer
Father's Zip Code (if different from mother's)
Your answer
Specify number of grandparents attending.
Your answer
Specify number of godparents attending.
Your answer
Contact Person *
Your answer
Is contact person a member of New Salem?
Child's Middle Name *
Your answer
What is relationship to contact person?
Your answer
Work Telephone
Your answer
Home Telephone
Your answer
Email
Your answer
Your answer
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