Name of Child to be Dedicated *

First Name

Last Name

Birth Date of Child *

MM

DD

YYYY

Gender of Child *

Male

Female

Contact Person *

Mother

Father

Are the parents of this child married? *

Yes

No

Have you previously dedicated a child at Faith Fellowship? *

Yes

No

Father's Name

First Name

Last Name

Best contact phone number for Father of Child

(###)

###

####

Has the Father received Jesus as their Lord and Savior?

Yes

No

Mother's Name

First Name

Last Name

Best Contact Phone Number for Mother of Child

(###)

###

####

Has the Mother received Jesus as their Lord and Savior?

Yes

No

In addition to completing this form to the best of my ability, I agree to attend the next scheduled Child Dedication Class explaining the purpose of Child Dedication, and my responsibility as a Christian parent(s). *

Yes

No