Child Dedication Application

Child Dedication Application
Date of Application*

MonthDayYear
Date
Hour MinutesAM/PM Option
Requested Date of Dedication (Saturdays ONLY)*

MonthDayYear
Date
What is the number of all attendees (Including Parents & siblings)?*
MAXIMUM OF 20 ATTENDEES
Contact Person
Contact Name*

First NameLast Name
Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email*
example@example.com
- Child's Info
- Name of Child*
  
  First NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
- Place of Birth (City, State, Country)*
- Enter Initials That Child's Information Is Correct*
- Father's Info
- Father's Name *
  
  First NameMiddle NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Primary Number*
  Format: (000) 000-0000.
- Mobile Number
  Format: (000) 000-0000.
- Work Number
  Format: (000) 000-0000.
- E-mail
  example@example.com
- Mother's Info
- Mother's Name*
  
  First NameMiddle NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Primary Number*
  Format: (000) 000-0000.
- Mobile Number
  Format: (000) 000-0000.
- Work Number
  Format: (000) 000-0000.
- E-mail*
  example@example.com
- I consent & acknowledge a meeting with an Elder is required prior to dedicationI do not consent to a meeting with an Elder
- Parent's Signature*
- Office Use Only
- YesNoOther
- YesNo
- YesNo
- Name of Elder Performing Dedication?
- Meeting With Elder Date
  
  MonthDayYear
  Date
- Sanctuary MinistersDeaconsAudioPraise & WorshipOther
- YesNoOther
- Should be Empty:

Child Dedication Application

Contact Person

Child's Info

Father's Info

Mother's Info

Office Use Only