Baby Dedication Form

Baby Dedication Form Please complete all sections of application. Date Submitted: ___/___/___ Baby Information: Gender: ___Male ___ Female

DOB: ___/___/____

First Name: _____________________ M.I.: ____ Last Name: _________________ Parents: (Mother) First Name: _____________________ M.I.: ____ Last Name: __________________ Address: ________________________________________ Apt: ____________ City: ___________________________ State: ____________ Zip Code: __________ Contact info: Phone _______________________ Email: ______________________ (Father) First Name: _____________________ M.I.: ____ Last Name: __________________ Address: _______________________________________ Apt: _____________ City: ____________________________ State: __________ Zip Code: __________ Contact info: Phone _______________________ Email: _____________________ Parents Marital Status: ____Married ___ Separated ___Divorced Have you accepted Jesus Christ as your Personal Savior? ____ No ____ Yes Are you currently a member of Speaking Spirit Ministries? ____No ____ Yes OFFICIAL

OFFICE USE

Follow up: ___________________________________ _________________

Dedication

date:

Comments: ______________________________________________________________________________