Baby Dedication Form February 01, 2017 All fields are required. Child's Name Child's Date of Birth Child's Sex MaleFemale Mother's Name Father's Name Telephone Number Your Email Mailing Address Date Requested for Dedication Secondary Date Requested for Dedication Service Requested for Dedication (pick one) Sunday - 1:00 p.m.Wednesday - 7:00 p.m. I hereby authorize a member of Southern Illinois Worship Center to dedicate my child Yes Name of Parent Authorizing * For your free DVD, please fill out a Media Request Form at the Connections Desk. share
