Baby Dedication Form

Child's Full Name *

Child's Date of Birth *

Name of Birth Hospital *

Gender *

Male

Female

Requested Month of Dedication *

(2nd & 4th Sabbaths)

Alternate Month if not available *

Mother's Full Name *

Father's Full Name *

Address *

Address

City

State/Province

Zip/Postal

Contact Phone Number *

Email Address *

Mother's Work Number

Father's Work Number

Is at least one parent a member of Kingsboro Temple? *

Yes

This is not a condition for baby dedication

Godmother's Full Name

Godfather's Full Name

Who will participate in the ceremony? *

Both parents

Mother only

Father only

Godparent(s)

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