Mother's Name *

First Name

Last Name

Father's Name *

First Name

Last Name

Contact Phone *

(###)

###

####

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

When would you like to dedicate your child? *

MM

DD

YYYY

Date option #2

MM

DD

YYYY

Which gathering? *

9am

11am

Child's FULL Name *

First Name

Last Name

Pronunciation (if different from spelling)

First Name

Last Name

Child's Birthday *

MM

DD

YYYY

Will other family members be joining you on the platform? *

Yes

No

Does either parent or any family members wish to pray for the child during the dedication? *

Yes

No

1. Please email TWO clear pictures of your child to info@redhills.church *

Okay

2. Make sure both pictures are at least MEDIUM resolution. (2400 X 1800px) *

Okay

3. Make shure both pictures are LANDSCAPE format (wide not tall). *

Okay