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Baby Blessing Contact Form

Please fill out this form to submit a request to have your baby blessed. Please complete all fields so as to expedite this process and you will be contacted shortly.

Thank you

(*) Denotes required fields
 
Today's date:   
Date Requested:
Mother
First Name*: 
Last Name*:  
Miracle Temple member?
Father
First Name*: 
Last Name*:  
Miracle Temple member?
Home Phone:
 
Alternate Phone:
 
 Email:*
 
Child
First Name:
Last Name: 
Birth date:
Male    Female

1st Date Available for Pre-Baby Dedication Meeting:
   
2nd Date Available for Pre-Baby Dedication Meeting:
    

Desire to reserve a room? View here for room choices.

Room: 

Desire to reserve the kitchen?   Yes  No

Would you like to add a picture to place on Baby Dedication Certificate? If so, please click here to forward.
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