First Name:
  
Last Name:
   
Phone:
   
Email:
   
Date of Dedication:
      
Child's Name:
   
Gender of child:
    Male Female
 


CHURCH INFORMATION:                     

Are you a member of SHACHAH?

  Yes    No

Are the parents members of SHACHAH?
  Yes    No

Are you (the parents) married?
  
  Yes    No

Are you (the parents) married to each other?
  
  Yes    No

Are you (the parents) a Born Again Christian?


  Yes    No

God Parents:
 
 
Message:
   



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