Baby Dedication Request Form - Shiloh Baptist Church

Child's Full Name *

First

Last

Date of Birth *

Hospital where child was born

Requested Month of Dedication *

Second Option *

Mother's Name *

First

Last

Father's Name *

First

Last

Full Address *

Address, City, State, Zip Code

Phone Number *

Email *

Best Time To Contact *

Morning
Afternoon
Evening

Are one or both parents born again Christians *

Yes
No

Are one or both parents members of Shiloh *

Yes
No

Due to the spiritual nature of the questions asked during the Baby Dedication Ceremony, it is helpful for the Pastor to understand the marital and living situation of both parents. Which of the following best describes the parents’ marital and living *

God Mother's Name *

First

Last

God Father's Name *

First

Last

Who will participate in Baby Dedication Ceremony *

Both Parents
Mother Only
Father Only
Godparent(s)

Check all that apply

185 Chandler St #3801

Phone

Baby Dedication Form

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185 Chandler St #3801

Phone