Baby Dedication – Royalhouse Chapel

Name of Mother *

First

Last

Does the mother attend Royalhouse Chapel? *

Name of Father *

First

Last

Does the father attend Royalhouse Chapel? *

Is the mother or guardian a Born Again Christian? *

Is the father or guardian a Born Again Christian?

Proposed date of dedication *

Are you planning a naming ceremony? *

When will the naming ceremony be held?

Tithe Card Number

Full name of child to be dedicated *

First

Last

Date of birth

Hospital of birth

Who will participate in the Child Dedication Ceremony?

Which of the following best describe the parent's/guardian?

Mother's Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Home/Phone Info for

Cell Phone *

Email

Father's Address* (If Different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone *

Email