Mother's Name:
Are you a member of Spirit of Life?:
Address:
Father's Name:
*Are you a member of Spirit of Life?:
*Address:


If either of you IS NOT a member of Spirit of Life, please list the church you belong to.

Church Name:
I, the mother DO NOT belong to any church
I, the father DO NOT belong to any church:
Are the mother & father of the child being dedicated married?:
Baby's First Name:
Baby's Middle Name:
Baby's Last Name:
Date of Birth:
Requested Dedication Date:
Do both parents plan to attend the Dedication?:
Godparent's Names:
*Godparent's Names:
How many people will be attending the Dedication?:
City, State: