Revised 4/2/13

INFORMATION CONCERNING BABY DEDICATIONS

AT HOPE UNLIMITED CHURCH.

Congratulations on your desire to dedicate your child to the Lord! Our church is eager to assist
you in this important matter. Baby Dedication ceremonies are usually conducted upon the
request of the parents and the family.

IMPORTANT: Turn the attached Request Form into the church office ONE MONTH prior to
the requested date.

BABY DEDICATION REQUEST FORM

If you would like to have a baby/child dedicated at HUC, please submit one form per child. Please be advised that your
requested Baby Dedication date is not confirmed until you have received confirmation from the Pastor.

CHILD’S INFORMATION

Child’s Full Name: ______________________________ Gender: Male Female

Date of Birth: _______/_______/_______ Hospital where child was born: _____________________

Month Day Year

Is the baby adopted: Yes, No.

(if Yes then provide legal documents)

Requested Month of Dedication: ________ Second Option: _________

PARENTS INFORMATION

Mother’s Name: ______________________________ Father’s Name: _______________________________

Full Address: _____________________________________________________________________________

(Please include City, State and Zip)

Home Phone Number: (___) _______ Email Contact: _________________________________________

Are one or both parents born again Christians? Yes No Still considering Unsure what this means

Are one or both parents members of/ regularly attend Hope Unlimited Church? Yes, No