Baby Dedication

Please fill out the form below or download and fill out the PDF.

Baby Dedication Request Date*
Boy or Girl*
- Boy
- Girl
Name
First Middle Last
Date of Birth*
Hospital*
Father's Name
First Last
Mother's Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone*
Email
God Parent(s)
Signature*
Signature Date*
Name
This field is for validation purposes and should be left unchanged.

Contact Us

Phone
(516) 292-3685

(516) 661-7920
Monday–Friday, 10 AM–6 PM

Visit Us
78 N Franklin St
Hempstead, NY 11550