August 31st, 2025

On the day of, please make sure to check in at the Connection Center to let us know you're present. *

First Parent's Name

First Name

Last Name

Second Parent's Name

****Only IF he/she will also be dedicating the child******

First Name

Last Name

Name & age of child

***Specify if months or years old*** Please fill out another form for another child.

Phone

(###)

###

####

Which service

Mailing Address

We will be mailing a Dedication Certificate and Photo.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country