Baby Dedication Registration Form
Baby Dedications are performed the second (2nd) Sunday of each month. Please call the office to schedule.
Date of Dedication:_______________________________
First Name:_______________________________________________________________ Cultural Origin__________________________________________________
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Middle Name: ___________________________________________________
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Cultural Origin______________________________________ Meaning:____________________________________________ Spiritual Meaning:___________________________________
Scripture:_______________________________________________________________
Names of Parent (s) _____________________________________________________ or Grandparents (if applicable)__________________________________________
Address: ____________________________________________ Apt/Unit #_______________ City-State: __________________________________________ Zip Code: ________________ Home Tel: ___________________________ Work Tel.: _________________________________
(Copy of this form to: Children and TV Ministries)
If the given name is a newly-created name (one that would not be in the research books), please indicate a preferred blessing to be spoken over that child. For example one that you (parents) would have liked to be spoken over you or one that is passed on through generations in your own family.
Unless otherwise requested, pictures will be taken during the pastoral blessing and taping will be done of Pastor Paul’s prayer. Copies of the pictures and a video will be mailed, along with the certificate, to the parents.
Certificate Information
Child’s Full Name: ___________________________________________________________ Date/Time of Birth: __________________________________________________________ Place of Birth (Hospital & City) ___________________________________________________
Cathedral of His Glory (336) 282-0679 www.cohglory.org !!

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