Baby Dedication Request

Date of Request:

mm/dd/year

Required

Child's name and Date of Birth :

Required

Enter Name and mm/dd/year

Parent Name(s)

father, mother

Required

God parents name(s)

names

Required

Phone:

example: xxx-xxx-xxxx

Required

Dedication Date

mm/dd/year

Required

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Revised 7/5/2019

4141 Old Fairburn Road Atlanta, GA 30349 404-349-6040

Office Hours: Monday-Friday 9 a.m. - 5 p.m.