The Pentecostals of Mandeville
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Baby Dedication Information Form
PLEASE SUBMIT FORM & 4-6 PHOTOS TO LACEYLYNE@HOTMAIL.COM BY WEDNESDAY, OCTOBER 15.
Parent's Contact Information
Father's First Name
Father's Last Name
Mother's First Name
Mother's Last Name
Phone Number
Email Address
Baby's Information
First Name
Last Name
Middle Name
Birthdate
Gender
Male
Female
Birth Time
Birth Weight and Length (X lbs., X oz. | X" long)
Hospital Name
Birth City + State
SUBMIT