CHILD'S INFORMATION
Child's Full Name
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Requested Month of Dedication
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Service Time
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Gender
Male
Female
Date of Birth
Hospital where child was born
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PARENT'S INFORMATION
Mother's Name
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Father's Name
____________________________________________________
Full Address
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City
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State
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Zip
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Marrital Status
Home Phone Number
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Father's Work Number
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Mother's Work Number
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Email Contact
____________________________________________________
GODPARENT'S INFORMATION
Godmother's Name
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Godfather's Name
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