Parent/Child Dedication Application

Parent/Child Dedication Application
We will have Parent/Child Dedications on Mother’s Day, May 10, 2026. If you are interested in having your child dedicated, please complete the form below. Applications need to be submitted no later than May 3 to give us time to prepare for this special event.
Child's FULL Name*
Date of Birth*

MonthDayYear
Date
MaleFemale
Place of Birth*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mother's Name*

First NameLast Name
Mother's Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Father's Name*

First NameLast Name
Father's Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
8:00 a.m.9:30 a.m.11:00 a.m.
Mother's DayOther
What Date Would You Like For the Dedication?*

MonthDayYear
Date
YesNo
PLEASE NOTE: Pastor Mark will contact you to set up a meeting time in-person or via Zoom.
Other questions/comments (optional)
Should be Empty: