MIZPAH COMMUNITY CHURCH – MOLINO

Blk 8, Lot 10, Progressive Village 15 Molino 2, Bacoor, Cavite

CHILD’S DEDICATION REQUEST FORM

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

CHILD’S INFORMATION (Please Print)

Child’s Full Name: Gender:  Male  Female
Date of Birth: / / Hospital where child was born:
Requested Date of Dedication:

PARENT’S INFORMATION
Mother’s Name: Father’s Name:
Address (Please include City, State and Zip):

Home Phone #: ( ) Email Address:

Cellphone #: ( )
Are one or both parents born again Christians?  Yes  No  Still Considering
 Unsure what this means
Are one or both parents members of [Mizpah Community Church]?  Yes No
Marital Status:  Married and Living Together  Never Married/Living Together
 Never Married/Not Living Together  Divorced
 Separated  Other (please explain):

GODPARENT’S INFORMATION
Godmother’s Name: Godfather’s Name:
Who will participate in the Baby Dedication Ceremony?
 Both Parents  Mother Only  Father Only  Godparent(s)

Rev. Rene M. Diamante ___________________

Mizpah Church Pastor Mizpah Church Officer
 MIZPAH COMMUNITY CHURCH – MOLINO
Blk 8, Lot 10, Progressive Village 15 Molino 2, Bacoor, Cavite

NAME OF SPONSORS
GODFATHER/NINONG GODMOTHER/NINANG
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