Southside Form

Baby Dedication Registration

Baby D Event Information

We are so glad that you are interested in participating with us in our Baby Dedication Celebration!  You have been entrusted with a precious gift of new life, and we look forward to partnering with you as you embark on this parenting journey.  We hope the Baby Dedication Celebration will be a memorable occasion for you and your family!  We hold multiple Baby Dedications a year and space is limited for each.  By registering here you are reserving your spot in a future Baby Dedication event.  The Southside Kids Director on your campus will then send you a message with more information about the next Baby Dedication event specifically for your campus.

Contact Information

Basic details we need to follow up with you

Southside Campus You Attend*
Parent 1 Name*
First Name*
Last Name*
Parent 1 Gender*
Parent 1 Date of Birth*
Parent 1 Phone Number*
Parent 1 Email Address*

Parent 2 Information

Optional - only fill out if Parent 2 is participating

Parent 2 Name
First Name
Last Name
Parent 2 Gender
Parent 2 Date of Birth
Parent 2 Phone Number
Parent 2 Email Address

Child's Information

Please register each child being dedicated

Child Name*
First Name*
Last Name*
Gender*
Date of Birth*
Child's Address*
Address Line 1*
Address Line 2
City*
State*
Zip*
Who does the child live with at this address?*
If the above answer is "other", please specify who the child lives with below