Child Dedication Sign-Up (WSC)

Sign-Up
Choose Your Preferred Dedication Date*
Mother's Name:*

First NameLast Name
Father's Name:*

First NameLast Name
Child's Full Name (how you want it to appear on the certificate)*

First NameMiddle NameLast Name
MaleFemale
Child's Date of Birth*

MonthDayYear
Date
The Child Dedication class is a prerequisite in order to have your child dedicated here at Church of the Rock. If this is the 2nd (or more) child being dedicated, you are not required to take the class again.
Have you taken the class with a previous child?*

YesNo
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Should be Empty: