Requested Date for Baby Blessing


First Choice (req):

Second Choice (req):

Third Choice:

(These request for Dates are all based on availability)


Child's Information


First Name (req):

Last Name (req):

Middle Name:


Parent Information


Mother's Name (req):

Father's Name (req):


Contact Information


Street Address (req): City (req):

State (req): Zip (req):

Phone (req): Email (req):


Church Affiliation


I am a member of New Life.
I am a member of another SDA Church (Fill In SDA Church Name below)
No Church Affiliation

SDA Church Name:


Name of Individual Submitting Request


Requester Name (req):

Relationship to Child:
Mother
Father
Other (fill out box below)

Relationship to child: