Father's Name:     Mother's Name: 

I/we would like to participate during the following service:  
Saturday, October 9, 6:00pm Sunday, October 10, 9:00am  
Sunday, October 10, 10:45am

Baby/Child #1 (full legal name):

Birth date: Birth place (city and state):

Baby/Child #2 (full legal name):

Birth date: Birth place (city and state):

Baby/Child #3 (full legal name):

Birth date: Birth place (city and state):

Address: 

City:    State:    Zip Code: 

Home Phone:   

Cell Phone:      

Work Phone:    

Email Address: 

Additional comments or questions: