Dedication Form

Please be sure to enter all the information requested below.  This will help us in filling out your Baby/Child Dedication Certificate.  We prefer this form to be submitted online, but if you prefer to download the form, please click here.

Address:  1930 Adee Avenue
Bronx, NY 10469

Telephone: 718 547-4927

Fax: 718 547-3501

Your Name
First Name of Child
Middle Name of Child
Last Name of Child
Birth Date of Child
Place of birth (hospital)
Mother's Full Name
Father's Full Name
Godmother's Name
Godfather's Name
Date of Dedication
Email Address
Your Questions or Comments
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