May 10 & 11

* Please select the service you will be attending


* Please click 'Browse' to upload your child's photo. Please note that file sizes must be 2mb or less.
* Child's First Name:
* Middle Name:
* Last Name:
* Gender:  Male Female
* Child's Date of Birth:
* Parents' Names:
* Phone:
* Email:

(Please use this area to include any additional information that you feel we should know regarding the information on this form or your participation in the dedication.)
Special Comments: