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ICC Kids Baby Dedication
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Form Entry
Child's First Name
Child's First Name is required.
Child's Middle Name
Child's Middle Name is required.
Child's Last Name
Child's Last Name is required.
Child's Birthday
Child's Birthday is required.
Parent First Name
Parent First Name is required.
Parent Last Name
Parent Last Name is required.
Parent's Anniversary
Parent's Anniversary is required.
Parent Email
Email address is not valid
Parent Email is required.
Parent Phone
1
1
52
Parent Phone is required.
Spouse First Name
Spouse Last Name
Spouse Phone Number
1
1
52
Spouse Email Address
Email address is not valid
Are you members at ICC?
Yes
No
Are you members at ICC? is required.
Campus
North
Brownsville
Matamoros
Online Campus
Campus is required.
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