Baby Dedication January 19, 2025

Question Title

* 1. Parent Information

Mother's Full Name

Father's Full Name

Street Address:

City/State:

Zip:

Email:

Phone Number:

Are you legally married:

Question Title

* 2. Baby Information

Full Name

Date of Birth

Gender

Place of Birth

City/ State

Zip

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* 3. Baby Dedication Picture: upload here or email to businessoffice@pleasanthillmbc.org

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.