Baby Dedication Application

*For parents considering dedicating their child at Pocono Community Church*

(TO BE SUBMITTED AT LEAST ONE MONTH PRIOR TO THE PROPOSED DEDICATION DATE)
Baby's full name:
Baby's Date of Birth:
Select one:
  • Male
  • Female
Siblings:
PARENT INFORMATION Mother's full name:
Father's full name:
Marital status:
  • Married
  • Single
  • Divorced
Address: (number and street or P.O. Box)
City:
State:
ZIP:
Telephone:
Email:
How long have you been attending PCC?
Note: