child Community Dedication Request

Please Note: After filling out this form, you will be contacted with further instructions. To have your child or children dedicated in a Sunday morning service, parents must be married and attending the Embassy Church. If the situation is different, a private dedication with family and friends may be done by the Pastoral Care.

Baby's First Name

Baby's Last Name

Baby's Middle Name

Date of Birth

Birthplace

Gender
Male
Female

Father's First Name

Father's Last Name

Mother's First Name

Mother's Last Name (And Maiden Name)

Email Address

Phone Number

Address 1

Address 2

City

Province

Postal Code

Country

Will both parents attend the dedication service?
Yes
No

Marital Status
Married
Common Law
Single

Send

child Community Dedication Request

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