EmailMeForm
Child Dedication Request Form
Please complete this form to request a Baby/Child Dedication.
Family Name:
*
Father's First Name:
*
Mother's First Name:
*
Father and Mother Are...
*
Married
Not Married
Date of Marriage:
*
MM
/
DD
/
YYYY
Child's Complete Name:
*
Multiple Choice
*
Male
Female
Child's Date of Birth:
*
MM
/
DD
/
YYYY
Child's Place of Birth:
*
Please enter City and State
Siblings:
God Parents:
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Phone Number:
*
###
-
###
-
####
Email Address:
*
I Would Like To Dedicate My Child At/During...
*
9am Sarasota Campus
11am Sarasota Campus
10:30am Palmetto Campus
7 pm Saturday - Portuguese Service
Please upload a photo of the child being dedicated
*
