Baby Dedication Request

Congratulations on the birth of your child(ren).



We are excited about the opportunity to commemorate this blessing as you seek to dedicate your child(ren) back to God in the presence of your church family. If your child is less than 8 months old, please fill out the form below so we can schedule your date. Someone from my office will contact you in 3 business days to verify the date and work out all of the details of this blessed event.

Looking forward to celebrating with your family.

Sincerely,

The Reverend Dr. Robert C. Scott
Senior Pastor

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What is your first date choice?(*)
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What is your second date choice?(*)
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What is your third date choice? (Optional)
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How many people do anticipate sitting with your family?(*)
Numbers only

All members should be in place 10 minutes before the start of worship service. If you are not in place at that time, you baby dedication will be rescheduled at another date.

Full Name of Your Child(*)
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Sex(*)
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What is your Baby's birthdate?(*)
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Birth Time
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Birth Weight(*)
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Birth Length(*)
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What is the Marital Status of the Parents?(*)

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What is the Mother's Full Name? (First, Middle & Last Name)
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Is the Mother: (Check all that apply)

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Mother's Home Phone(*)
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Mother's Cell Phone
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Can the Mother receive text messages?
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Mother's Email Address
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What is the Father's Full Name? (First, Middle & Last Name)
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Is the Father: (Check all that apply)

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Father's Home Phone(*)
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Father's Cell Phone
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Can the Father receive text messages?
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Father's Email Address
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What is the God Mother's Full Name? (First, Middle & Last Name)
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Is the God Mother: (Check all that apply)

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What is the God Father's Full Name? (First, Middle & Last Name)
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Is the God Father: (Check all that apply)

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What is the Maternal Grandmother's Full Name? (First, Middle & Last Name)
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(The Mother's mother)

What is the Maternal Grandfather's Full Name? (First, Middle & Last Name)
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The Mother's Father

What is the Marital Status of the Maternal Grandparents?(*)

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What is the Paternal Grandmother's Full Name? (First, Middle & Last Name)
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(The Father's mother)

What is the Paternal Grandfather's Full Name? (First, Middle & Last Name)
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The Father's Father

What is the Marital Status of the Paternal Grandparents?(*)

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Full Name of All Siblings
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List Additional Parents (Step, Step Grand, Great-Grand, etc.) to be recognized.
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Please upload a picture of your child
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