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CHILD DEDICATION APPLICATION FORM

Name of Child *

First

Last

Name of Mother *

First

Last

Address of Mother *

Is the mother a born again believer? *

• Yes
• No

Name of Father *

First

Last

Address of Father *

Is the father a born again believer? *

• Yes
• No

Names of God-Parents (if any)

Date of Dedication

What amount do you intend to contribute before the dedication of your child? *

During Sunday Service? *

• Yes
• No

Phone Number *

Your phone number

Email *

Your email address

Submit