Request Form

The Fountain Church will have baby dedications quarterly. Please complete the form, and someone from the team will follow up with you as soon as possible to plan the next steps for your baby's dedication.
Parents are required to attend a brief parent pre-dedication meeting? Please select a date.
Parent/Guardian 1

First NameLast Name
Parent/Guardian 2

First NameLast Name
Home Phone

Area CodePhone Number
Parent/Guardian 1 Cell Phone

Area CodePhone Number
Parent/Guardian 2 Cell Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Member Since (Parent/Guardian 1)
Member Since (Parent/Guardian 2)
Baby's Information
Baby's Full Name (as it appears on the birth certificate):

First NameMiddle NameLast Name
Baby's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sex of Baby
Please attach a photo of your baby.

Browse Files

Cancelof
Please share any other information that you would like for us to know.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Approval Status
Approval Signature
Should be Empty: