Parent or Guardian's Name First Last Email Phone*Child's Name* First Middle Last Child's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920File*Please attach 2-4 high quality pictures of your child. These photos will be used to make a video to show the day of Child Dedication during service. Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, Max. file size: 128 MB, Max. files: 4.
