Baby Dedication Request

Contact Name(Required)

First Last

State(Required)

Contact Phone(Required)

Contact Email(Required)

Child's Name(Required)

First Last

Child's birthday(Required)

Gender(Required)

Mother's Name(Required)

First Last

Father's Name(Required)

First Last

Are the child's parents married to one another?(Required)

Do the child's parents reside in the same household?(Required)

Mother's relationship status(Required)

Father's relationship status(Required)

With whom does the child reside?(Required)

Are either parents a member of Destiny Church?(Required)

Is a grandparent of the child a member of Destiny Church?(Required)

Please list as best you can all significant people who will be present at the Baby Dedication and their role in the child's life.(Required)

Is there any additional information you think is important for us to know about your family situation?(Required)