Date requested for dedication service:

Mother:

Father:

Marital Status:

It is the policy of the church that only the child of a married couple or an adopted child can be dedicated on Sunday morning during Worship Service. All other dedications will take place any day during the week upon request.

Baby's name:

Date of birth:

Place of birth:

God Parents:

1:

2:

3:

4:

Items needed for dedication:

A white carnation for Mother and each Godmother

A red carnation for Father and each Gofather

* Please complete in full and return to Pastor