Baby's Name *

First Name

Last Name

Baby's Birthdate *

MM

DD

YYYY

Phone *

(###)

###

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Dedication Date Requested *

MM

DD

YYYY

Service Time Requested

Saturday 6pm

Sunday 9am

Sunday 11am

Check All That Apply

I/We the parent(s), am/are born again and have a personal relationship with Jesus Christ.

I/We regularly attend Refuge

I am a single parent.

I/We will endeavor, the the best of my/our ability, to raise my/own child in an environment of grace and Christian nurture.

I/We have read the Baby Dedication PDF above.