Mother's Name *
Mother's Name
Father's Name *
Father's Name
Contact Phone *
Contact Phone
Mailing Address *
Mailing Address
When would you like to dedicate your child? *
When would you like to dedicate your child?
Date option #2
Date option #2
Which gathering? *
Child's FULL Name *
Child's FULL Name
Pronunciation (if different from spelling)
Pronunciation (if different from spelling)
Child's Birthday *
Child's Birthday
Will other family members be joining you on the platform? *
Does either parent or any family members wish to pray for the child during the dedication? *
PHOTO CRITERIA (for slide and certificate)
1. Please email TWO clear pictures of your child to *
2. Make sure both pictures are at least MEDIUM resolution. (2400 X 1800px) *
3. Make shure both pictures are LANDSCAPE format (wide not tall). *