Child Dedication Sign Up
We are so glad you are interested in dedicating your child to Jesus! Please fill in this form and submit it. Fill out a separate form for each child if you are dedicating more than one.
Child's Name
*
First Name
Last Name
Child's Gender
*
Please Select
Male
Female
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Parent(s) Dedicating Their Child?
Please Select
Father
Mother
Both Father and Mother
Mother's Name
First Name
Last Name
Have you, the mother, committed your life to following Jesus?
Please Select
Yes
No
Father's Name
First Name
Last Name
Have you, the father, committed your life to following Jesus?
Please Select
Yes
No
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Do you attend The Word Church regularly?
*
Please Select
Yes
No
Briefly tell us why you desire to dedicate your child.
*
Do we have your permission to take pictures of your family during the dedication for The Word Church media purposes?
*
Please Select
Yes
No
Submit
Should be Empty: