EmailMe Form - DEFMI Baby Dedication Form

A PROCESSING FEE of $25 is required for the completion of this application. Members are exempt from payment.
VISIT
https://www.defmi.tv/product/defmi-baby-dedication-processing-fee/ *
Agree
Child's Name *
First Middle Last
Date if Birth *
MM / DD / YYYY
Child’s Place of Birth/ Hospital *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Father's Name *
First Last
Father's Phone Number *
### - ### - ####
Mother's Name *
First Last
Mother's Phone Number *
### - ### - ####
Email
Name of Witness (Godparent)
First Last
Name of Witness (Godparent)
First Last
Name of Witness (Godparent)
First Last
Name of Witness (Godparent)
First Last
Name of Witness (Godparent)
First Last
Name of Witness (Godparent)
First Last
Name of Witness (Godparent)
First Last
Are you a member of ?
Divine Encounter Fellowship - Ragoo Rd.
Divine Encounter Covenant Centre - Sangre Grandy
Divine EncounterLife Centre - Chaguanas
Divine Encounter Harvest Centre - Mayaro
Do you agree that all of the above is accurate? *
YES
NO
Current Date *
MM / DD / YYYY