Baby Dedication Parent or Legal Guardian Name(s) * First Name Last Name First Name Last Name Relationship to Child * Child Being Dedicated * First Name Last Name Pronunciation of Your Child's Name Child's Date of Birth * MM DD YYYY Child's Gender: * Select Male Female Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Do you attend Bethel Temple Church? * Yes No If no, where do you attend? Would you be willing to sign a photo release form for use of your child's picture in possible future Bethel Temple Church promotions? * Select Yes No Thank you!
