Please feel free to contact our Administrative Office at (919) 774-9462 or e-mail questions to info@christianprovision.com.


Month & Year of Baby Dedication:

Child's Full Name:

Gender:

MaleFemale

Child's Age: (Must be 3 years old or younger)

Child's Birth Date:

Name of Father:

Name of Mother:

Best Phone#:

Email:

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