Child Dedication

Contact Information

Parent Name

First Name

Last Name

Email

Phone

(###)

###

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Spouse Name (If Applicable)

First Name

Last Name

Child's information

Please tell us about each child you'd like to dedicate

Please list the name, age and gender of each child you would like to dedicate. Please separate each child with a comma. (Ex. John Smith 18months Male, Mary Sue 12wks Female)

We are excited that you want to dedicate your child to the Lord! After completing the form, we will be in contact to get you set up for the next scheduled date.