CHILD DEDICATION APPLICATION

Parent/Guardian Name

First Name

Last Name

Are you a follower/disciple of Jesus?:

Yes

When did you make your personal profession of faith in Jesus Christ?:

Briefly share your Grace Story:

Parent/Guardian Name (2)

First Name

Last Name

Are you a follower/disciple of Jesus?:

Yes

When did you make your personal profession of faith in Jesus Christ?:

Briefly share your Grace Story:

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone

(###)

###

####

Secondary Phone

(###)

###

####

Will your other children be on stage? If so, how many?:

Child's Name

First Name

Last Name

Pronunciation:

Child's Birthdate:

YYYY

Gender:

Male

Female

Is there a spiritual significance to why you chose your baby's name?:

PLEASE SEND 2-3 PICTURES OF YOUR CHILD NO LATER THAN ONE WEEK IN ADVANCE FROM YOUR SCHEDULED CHILD DEDICATION