WE ARE SO EXCITED YOU WANT TO DEDICATE YOUR CHILD AT REFUGE. PLEASE TAKE A MOMENT TO READ THIS PDF, THEN FILL OUT THE FORM BELOW, AND SOMEONE WILL BE IN CONTACT WITH YOU SOON!

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: *