Baby Dedication Request

Please fill out this form and click submit.

Baby's name

*

Baby's Date of Birth:

*

Baby's Gender

*

Please select one option.

Male Female

Requested Date

*

Alternative Date

Parent's Information

Mother's Name

*

Is Mother a Member of Star

*

Please select all that apply.

Yes No

Mother's Phone

*

Mother's Email

*

This address will receive a confirmation email

Mother's Address

Father's Name

*

Is Father a Member of Star

*

Please select all that apply.

Yes No

Father's Phone

*

Father's Email

*

This address will receive a confirmation email

Father's Address

Have both parents accepted Christ as their Lord and Savior

*

Please select all that apply.

Yes No

Are Parent's listed above married

*

Please select all that apply.

Yes No

If not, do parent's live together

*

Please select all that apply.

yes no

Godmother's Names:

Godfather's Names:

Are the Godparents saved

Please select all that apply.

Yes No

Description

Please fill out this form and click submit.

Please Fix the Following

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