BABY DEDICATION FORM – Patmos Chapel

CHILD'S INFORMATION

Child's Full Name *

Child's Date of Birth *

Name of Birth Hospital *

Gender *

Male

Female

Requested Month of Dedication *

(2nd & 4th Sabbaths)

Alternate Month if not available *

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PARENT'S INFORMATION

Mother's Full Name *

Father's Full Name *

Address *

Contact Phone Number *

Email Address *

Mother's Work Number

Father's Work Number

Is at least one parent a part of a ministry at Patmos Chapel? *

Yes

This is not a condition for baby dedication

Is at least one parent a member of Patmos Chapel? *

Yes

This is not a condition for baby dedication

Due to the spiritual nature of the questions asked during the Baby Dedication Ceremony, it is helpful for the Pastoral Team 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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GODPARENTS INFORMATION

Godmother's Full Name

Godfather's Full Name

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Who will participate in the ceremony? *

Both parents

Mother only

Father only

Godparent(s)

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