Baby Dedication

Baby Dedication Application Form
Father's Name*

First NameLast Name
Mother's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
Email*
Child dedication services are intended to uphold the Biblical standard that we teach. Please note parents who are living together and are not married are asked to kindly refrain from requesting this particular service. We thank you for your understanding.
Marital Status*

SingleMarried
Are you a Born-Again Christian?*

Father - YesMother - YesFather - NoMother - No
Have you completed the Joining Our Church Family membership course?*

Father - YesMother - YesFather - NoMother - No
Which campus do you regularly attend?*

Montclair CampusRockaway CampusLodi Campus
Number of attendees coming to the Baby Dedication service*
Number of children to be dedicated? (Age requirement – 3 years or younger)*

123
Child #1 Information*
Child #2 Information*
Child #3 Information*
Should be Empty:

Baby Dedication Application Form