CHILD DEDICATION APPLICATION 2026

Your name *

Email address *

Phone number

Address

Primary Location *

PARENT / GUARDIAN 1 INFORMATION

FULL NAME *

I HAVE ACCEPTED JESUS AS MY LORD AND SAVIOR *

FULL NAME

I HAVE ACCEPTED JESUS AS MY LORD AND SAVIOR *

ARE THE PERSONS LISTED ABOVE MARRIED TO EACH OTHER? *

DO YOU LIVE AT THE SAME ADDRESS *

DEDICATION LOCATION *

CHILD 1 | NAME *

NAME AS YOU WANT IT TO APPEAR ON THE DEDICATION CERTIFICATE

CHILD 1 | DATE OF BIRTH *

CHILD 2 | NAME

NAME AS YOU WANT IT TO APPEAR ON THE DEDICATION CERTIFICATE

CHILD 2 | DATE OF BIRTH

CHILD 3 | NAME

CHILD 3 | DATE OF BIRTH

A copy of your responses will be sent to your email address.