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.

* Indicates Response Required


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