GracePointe

I want to dedicate my child to the Lord...

Baby's First and Last Name (If you have more than one child, please list all of them by first and last name)

Mother's First Name (Parent's name will be printed on your child's certificate)

Mother's Last Name

Email*

Phone

Father's First Name (Parent's name will be printed on your child's certificate)

Father's Last Name

3900 Lake Blue Dr.

Winter Haven, FL 33881

PH: 863-268-7940

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