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We're so excited you want to dedicate you child here at Refuge! Please take a moment to read our PDF by clicking the button, and then fill out the form below. Someone will be in contact with you soon!


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BABY'S NAME: *
BABY'S NAME:
BABY'S BIRTHDATE: *
BABY'S BIRTHDATE:
PHONE NUMBER: *
PHONE NUMBER:
DEDICATION DATE REQUESTED: *
DEDICATION DATE REQUESTED:
SERVICE TIME REQUESTED: *
CHECK ALL THAT APPLY: *