RCC Baby/Child Dedication Registration Form

Please be sure to enter all of the information requested below.  This will help us in filling out your Baby/Child Dedication Certificate.

Please type in the Full Birth Name of the Child to be Dedicated:

        First Name               Middle Name                     Last Name
       

Child's Date of Birth:         

Place of Birth (Hospital): 

City:      State: 

Father's Full Name: 

Mother's Full Name: 

Home Phone:  (example: 919-266-7000)

E-mail Address: 

Any additional information you'd like to give us:

Please sign me up for the next baby dedication scheduled for