Baby Dedication Request Form

The Greater Piney Grove Baptist Church
1879-1921 Glenwood Ave. Atlanta, Georgia 30316
Ph: 404.377.0561 Fax: 404.373.1752
Dr. William E. Flippin, Sr. Senior Pastor, B.A., M.Div., D.Min

Submitted by: First Last
Baby dedications are for members of The GPGBC and at least one parent has to be a member. Friends and family members other than the parents, grandparents and godparents are asked to stand at their seats during this sacred event.
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Baby dedications are for members of The GPGBC and at least one parent has to be a member. Friends and family members other than the parents, grandparents and godparents are asked to stand at their seats during this sacred event.
Request Date: / MM / DD YYYY
Alternate Date: / MM / DD YYYY
Class Date: / MM / DD YYYY
Child's Full Name: Title First Last Suffix
Date Of Birth: / MM / DD YYYY
Place Of Birth:
Hospital Of Birth:
Dedication Picture (Would you like a picture by our church photographer?) Yes No
Mother's Name: First Last
Grove Member? Yes No
Home Phone: - (###) - ### ####
Cell Phone: - (###) - ### ####
Email:
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Marital Status:
Father's Name: First Last
Home Phone: - (###) - ### ####
Cell Phone: - (###) - ### ####
Email:
Address (If different from mother):
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Number Of Godparents Attending:
Number Of Grandparents Attending:
Grandparents:
Godparents:
Pre-interview for contact person:
Grove Contact: First Last
Home Phone: - (###) - ### ####
Cell Phone: - (###) - ### ####
Grove Members Related To Family:
1. Have you updated your membership at GPGBC for the current year?
2. What services do you attend on a regular basis? 7:30 9:30 11:30
3. In what Sunday Church School/Bible Study classes are you enrolled or have been enrolled?
4. What areas of the Church are you serving?
5. Are both parents committed Christians? If not, please describe spiritual affiliation.
6. Are all of the persons you have selected as godparents committed Christians? If not please describe their spiritual affiliation.

Baby Dedication Request Form

Baby Dedication Request Form

Pre-interview for contact person: