Baby Dedication Registration Form

If you would like to participate in our baby dedication, happening on January 14th, 2023, please fill out this form to register.

Parent filling out form

*

Children Information

Child 1's Full Name

*

Child 1's Gender

*

Please select one option.

Male Female

Child 1's Birthday

*

Child 2's Full Name

Child 2's Gender

Please select one option.

Male Female

Child 2's Birthday

Parents Information

Dad's Name

*

Mom's Name

*

Address

*

Phone

*

Email

*

This address will receive a confirmation email

Are one or both parents born-again Christians?

*

Please select one option.

Both Dad Only Mom Only Neither

Are one or both parents members of PBC?

*

Please select one option.

Both Dad Only Mom Only Neither

Due to the spiritual nature of the Baby Dedication Ceremony, it helps us to understand the marital and living situation of both parents. Which of the following best describes the parents' marital and living situation.

*

Please select one option.

Married and living together Never married and living together Never married and not living together Divorced Separated Other

If you checked other to the previous question, please explain.

Please be advised that your Baby Dedication date is not confirmed until you have received confirmation from a PBC staff member.

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If you would like to participate in our baby dedication, happening on January 14th, 2023, please fill out this form to register.

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