Baby Dedication Registration
Please fill out this form and click submit.
Father's Name
*
Mother's Name
*
Number of Children Being Dedicated
*
Campus
*
Please select one option.
Ormond Campus
NSB Campus
Flagler Campus
Palm Coast Campus
Please write below the name(s) as you would like it to appear on the certificate(s)
List each child's name and birthdate
*
Address for mailing certificate
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Email
*
This address will receive a confirmation email
Phone
*
Submit
Description
Please fill out this form and click submit.
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