Infant Dedication Request  
We are committed to provide an infant dedication ceremony on the 2nd Sabbath of each month. Upon the completion of this form, a church clerk will contact you directly to confirm the requested date. 

This information is necessary for the preparation of the certificate and will be kept CONFIDENTIAL and will not be shared. 

This form must be submitted by the 30th of each month prior to the requested Sabbath via email to acchurchclerk@gmail.com

Sign in to Google to save your progress. Learn more

Are you a church member?

 *
Required
Do you have a family member who attends Apple Creek? 
What date would you like to have your Infant Dedication Ceremony? *
MM
/
DD
/
YYYY
What is the child's FIRST name and MIDDLE name? *
Middle name is optional
What is the child's LAST name? *
What is the child's Birth Date (D.O.B.)  ? *
MM
/
DD
/
YYYY
What was the child's weight at birth? ( optional ) 
What was the child's birth location? (Name of Hospital) 
Mother's FIRST name and LAST Name  *
Father's FIRST name and LAST Name  *
Parent(s) Phone Number  *
Parent(s) Email *
Please check your email inbox for further information regarding your request. "If you do not see the email please check your junk mail".
Parent(s) Full Address *
I would like to provide a photo of my child for the ceremony presentation
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms