Baby Dedication Request

Please fill out this form and click submit.

Child's Information

Child's Full Name

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Gender

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Please select one option.

Male Female

Date of Birth

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Hospital where child was born

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Requested Month of Dedication

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Please select one option.

March June September December

Parents' Information

Mother's Name

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Father's Name

*

Address

*

Phone

*

Email

*

This address will receive a confirmation email

Are one or both parents Christians?

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Please select all that apply.

Yes No

Are one or both parents members of Longley Baptist Church?

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Please select all that apply.

Yes, have completed orientation No

Due to the spiritual nature of the questions asked during the Baby Dedication Ceremony, it is helpful for the Pastor to understand the marital and living situation of both parents. Which of the following best describes the parents’ marital and living situation?

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Please select one option.

Married and living together Never married and not living together Never married and living together Divorced Separated Other

Godparents' Information

Godmother's Name

*

Godfather's Name

*

Who will participate in the Baby Dedication Ceremony?

*

Please select one option.

Both Parents Mother only Father only Godparents Grandparents

Description

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Please Fix the Following

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