Baby Dedication Request Form

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Mark 10
13 And they brought young children to him, that he should touch them: and his disciples rebuked those that brought them.

14 But when Jesus saw it, he was much displeased, and said unto them, Suffer the little children to come unto me, and forbid them not: for of such is the kingdom of God.

15 Verily I say unto you, Whosoever shall not receive the kingdom of God as a little child, he shall not enter therein.

16 And he took them up in his arms, put his hands upon them, and blessed them.

Email *

Phone Number (Parent Requesting) *

Requested Date for Ceremony (Dedications are only done on the 1st Sunday of the month) *

YYYY

Baby's Name *

Baby's Birthdate *

YYYY

Mother's Name *

Is Mother a Christian? *

Yes

If no, does mother practice any other faith besides Christianity?

Mother's Church (if applicable)

Father's Name *

Is Father a Christian? *

Yes

If no, does Father practice any other faith besides Christianity?

Father's Church (if applicable)

Will both parents take part in the ceremony? *

Yes

Why do you want to have your baby dedicated? *

Additional Comments

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