Baby Dedication Form | refugecity

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Baby Dedication Form

Thank you for choosing Refuge City to dedicate your child. Please be assured that your information will only be used for administrative purposes and will be held in the strictest confidence.

Requested Dedication Date (mm-dd-yyyy)

Mother's Name (first, last)

Email

Father's Name (first, last)

Phone

Mailing Address

Child's Full Name

Child's Date of Birth (mm-dd-yyyy)

Child's Hospital of Birth

Child's Gender

Female

Male

Anything else you would like to add?

Thank you for filling out your information! Your form has been submitted. Please check your email for more information.

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A Ministry With A Personal Touch

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