Baby Dedication Request Form

Requested Date for Dedication

Service Time

INFORMATION OF CHILD TO BE DEDICATED

Full Name

Sex

Male

Female

Date of Birth

City of Birth

State of Birth

Address

City

State/Province

Zip/Postal

Country

Phone

Please check the ones that apply

I'm a member of SBWC and I want my child to be dedicated.

I'm not a member of SBWC but I want my child to be dedicated - If you're a member at another church, what is the name of your church?

Name of your church

INFORMATION OF PARENTS IF YOUR CHILD IS BEING DEDICATED

Father's Full Name

Mother's Full Name

Date of Marriage

Address

City

State/Province

Zip/Postal

Country

Child's Full Name

Child's Date of Birth

City of Birth

State of Birth

Are you a member of SBWC

Yes

If yes, how long have you been a member?

INFORMATION OF GODPARENTS

Godfather's Name

Godmother's Name

Signature

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Shores Baptist Worship Center