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Child Dedication Request
Your name
*
Last name
Email address
*
Phone number
*
Phone type
Mobile
Home
Work
Other
Name of the child to be dedicated?
*
Gender
*
Select…
Male
Female
Birthdate
*
Date
Name of Parent 1
*
Name of Parent 2
*
Are the parents legally married?
*
Yes
No
Are the parents members of Riverside Church?
*
Yes
No
Any additional notes or instructions that you would like to share?
Submit
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