Baby Dedication Request
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Baby Dedication Request
Name of Adult Requester *
Address *
Phone
Email Address
Are you an active member of Rhema Deliverance *
Name of Youth  #1 *
Date of Birth #Y1 *
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/
DD
/
YYYY
Gender Y1
Clear selection
Name of Youth  #2
Date of Birth #Y2
MM
/
DD
/
YYYY
Gender Y2
Clear selection
Name of Youth  #3
Date of Birth #Y3
MM
/
DD
/
YYYY
Gender Y3
Clear selection
How soon are you requesting to be the Dedication? *
Additional Comments and/or Candidates
Submit
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