Baby Dedication Request Form

Child's Full Name: 

Date of Birth:   (mm/dd/yy)

Gender  choose gender boy girl

Father's Name: 

Is Father a Member of First Baptist Indian Rocks? Yes   No

Mother's Name: 

Is Mothter a Member of First Baptist Indian Rocks? Yes   No

Single parents, who are members are invited to participate after a meeting with the Pastor of the Singles Ministry prior to the Dedication Service. The preschool director will assist you with making this appointment.

Sibling Name:    Age: 

Sibling Name:    Age: 

Sibling Name:    Age: 

Address

Street: 

City: 

State:  choose state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Postal code: 

Home Phone: 

Work Phone: 

Cell Phone: 

Email Address: 

Please select a service for the dedication
choose service High Definition 9:00am Worship Center 10:45am

Do you have family planning to visit from out of town for the dedication?
Yes 
No