Baby Dedication Application

Springhill Baptist Church
941017 Old Nassauville Rd
Fernandina Beach, FL 32034
904-261-4741
http://www.springhillbaptistfb.org

Information on Child

Last Name *

First Name *

Middle Name *

Goes by *

Sex *

Birth Date *

Weight at birth *

Length at birth *

Age at Dedication *

Names of any siblings *

Parent Information

Parents names and occupations *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address

Married how Long

List any involvement in SHBC life
(Grace Group, Sunday School class, etc.) *

Names of any family members attending the
Dedication and their relationship to child

Names of anyone else attending
the Dedication

Life verse for child *

Please submit 2-3 dates for
Dedication *

Is there any significance to the name
given the child?

Please submit 2-3 dates for the Dedication. We like to only do one Dedication per Sunday and will also need to check dates submitted for other events already scheduled. Our church office will be back in touch with you after your application has been submitted.
Thanks.