Baby Dedications

Membership Information

1. Is the MOTHER a member of New Hope?
2. YesNo
3. Is the FATHER a member of New Hope?
4. YesNo

Child's Information

1. Child's LEGAL first name(required)
2. Child's LEGAL middle name(required)
3. Child's LEGAL last name(required)
4. Child's Date of Birth(required)

Dedication Date Elections

1. Month for Dedication (1st Choice)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember(required)
2. Month for Dedication (2nd Choice)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember(required)

Mailing Information

1. Street Address(required)
2. Address Line 2
3. City(required)
4. StateAR(required)
5. Zip Code(required)

Contact Information

1. Primary Phone(required)
2. Secondary Phone
3. Email(required)
4. Mother's Name (First and Last)(required)
5. Father's Name (First and Last)(required)
6. Additional Notes

Verify you're human

1. Ten minus five equals