Baby Dedication Registration

Name of Candidate*

First Middle Last

Gender*

Date of Baby Dedication*

Date of Birth*

City/State where child was born*

City State / Province / Region Country

Mother's Name*

First Last

Father's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Contact Number*

Contact Email*

Enter Email Confirm Email

Are one or both parents members of Eagles Nest Church?*

Please upload a high quality picture of the baby*

Accepted file types: jpg, jpeg, png, gif.

In one sentence, tell us something cute you would like us to know about your little one.

Who will participate in the Baby Dedication Ceremony?*