Baby Dedication Request Form

This form is to request a baby's dedication to the Lord. Baby dedications are conducted on the 2nd Sunday of each month, except for the month of October and November where it will be conducted on the 3rd Sunday. Dedications must be scheduled a minimum of 6 weeks prior to the requested date.

Requestor Name*
Contact Email address*
Enter Email Repeat Email
Contact Phone Number*
Address*
Street Address Address Line 2 Town State / Province / Region ZIP / Postal Code
Requested Dedication Date
Date Format: MM slash DD slash YYYY
Full Name of Baby*
Baby's date of birth
Date Format: MM slash DD slash YYYY
What is the Baby's City and State of Birth*
Mother's Full Name*
Is mother a member of New Jerusalem
- Yes
- No
Father's Full Name*
Is father a member of New Jerusalem
- Yes
- No
Godmother's Full Name
Godfather's Full Name
Phone
This field is for validation purposes and should be left unchanged.